Posts filed under POSTPARTUM

Returning To Work As A Breastfeeding Mother with Emma Pickett

Smart Sexy Birth | Tips on going back to work and breastfeeding

We have a very special guest today! Emma Pickett is a lactation consultant who works and lives in England and has agreed to grace us with her words of the wise on going back to work while continuing to breastfeed.

I have to admit me and the breast pump never got along very well, but I also have to admit that my attempt was pretty half-assed.  I never had to pump which probably played a larger part in my lack of success.  

I know this topic is a hot one for many many mamas across the board so without further ado I will hand it over to Emma.  This is an article that she had written previously on her blog that she adapted for us north americaners.....I was truly astonished, as she points out below, that the U.S. actually has better breastfeeding stats compared to England, even when they recieve 6 + months of maternity leave compared to our puny 8-12 weeks here.  I was also flat out amazed that England does not have any laws in place for a woman to have pumping rights in the work place!  The U.S. still has a long way to go in supporting its mama but it turns out we do have some things in our favor.

Happy reading.....and happy breastfeeding!



I’m a lactation consultant in the United Kingdom and I commonly work with breastfeeding mums who are returning to work and keen to protect their breastfeeding relationship.

In the UK, mums regularly return to work after six months of full-time care of baby and twelve months isn’t at all unusual. I take my hat off to any mother who is returning to work after just a few weeks and is determined to make breastfeeding work. It’s hard but women manage it every single day. And despite the much longer maternity leave in the UK, American mothers exclusively breastfeed to six months in greater numbers than the British do. You also have greater numbers doing any breastfeeding at six months. We really don’t deserve to be smug.

Mothers are deployed in the military to foreign countries and STILL manage to pump milk and ship it home. Women work night shifts and have several children. They have babies with special needs or special needs themselves. With the right pump and a bit of organisation, you can keep your baby exclusively fed on breastmilk for as long as you want to.

It works for American mums because you have state and federal law that protects your right to continue to give your baby the milk that makes sense. It’s not just about employers being lovely and kind. These laws exist because they make sense for everyone. It means less absence (as breastfed babies are less likely to be ill with conditions like diarrhoea and respiratory infections and ear infections). It means better employee recruitment and retention and better employee morale and productivity.

The first few days and weeks are often a blur for new mums. The learning curve is steep and you survive day to day – remembering to shower and put food in the fridge for yourself if you are lucky. For those mums still in the middle of that blur, the thought of the eventual return to work can be one that provokes anxiety.

You can’t imagine how it will feel to leave this new special person in your life.

How do you people cope with drop-offs to childcare and getting back to work after potentially several night-wakings?

What do you do if you don’t want to give up breastfeeding?

Here are my SEVEN top tips for returning to work as a breastfeeding mum.


 1. Don’t think about it.


OK, now I don’t mean that too literally. My message is just that if you are going to take 6 weeks, 3 months or a year off work and you spend most of that stressing about the return to work, you will be seriously missing out.


STOP yourself thinking about it too much. If you stare at your gorgeous three week old and think fleetingly, “How can I ever leave you?” (which is how nature very much wants you to feel), that is fair enough. But if you spend chunks of your maternity leave feeling anxious and worrying about practicalities, you will be wasting the special times you do have together.


This time is precious. Your baby now is not going to be the same person when you return back to work. They will sleep differently, feed differently, and interact differently. You will not be leaving THIS baby but an older one.  So get your childcare sorted (which you will have thought about in pregnancy anyway) and other than that, there’s not too much more to do! If you intend to express milk at work, it’s a good idea to speak to your employer before you go back to work to talk about arrangements. It makes sense to find out in pregnancy how things work at your workplace and what systems are already in place. And then just carry on as normal. Don’t jeopardise breastfeeding by focusing too much on the return to work. We don’t need a baby that is only a few days old to be taking a bottle. We want them to learn how to latch correctly on the breast so you are comfortable, they can transfer milk effectively and we give your supply the best chance we can. When you are really happy with the latching, then you might try and express some milk and experiment giving it to baby. If they don’t immediately take to a bottle, don’t panic! It’s very easy to set yourself into a panic when the truth is that things usually work out with the right information and the right support. The person who gives the bottle when you are away from baby is going to have their own strategies and probably their own experience and baby will know it’s not you. Babies can also be fed milk in other ways if the bottle really really isn’t accepted. There’s cup feeding and syringe feeding and even finger feeding using a feeding tube. The world doesn’t end if a baby doesn’t take a bottle so don’t spend the start of baby’s life stressing about it.


 2.  As mentioned, speak to your employer.


Talk to them when you are pregnant. Find out what your rights are. What have other colleagues done? Is there a workplace buddy who can offer you practical and emotional support?


 3.  Talk through your schedule with a breastfeeding counsellor or lactation consultant.


Chat through your expectations. How often do you need to pump? How much breastmilk does a baby take in a bottle when they are away from mum? (The milk calculator on is useful for this). Is there a way to get in some extra breastfeeds in the day? Could you visit baby in your lunch hour? Maybe do a feed when you collect baby rather than wait until you get home? Maybe it makes sense to pump again at home just before you go to sleep?


4. Talk to your partner and family.


Your partner needs to know why this matters. They need to know that you are going to need time to pump at home too and they are going to need to help take some responsibility for home life running smoothly (please tell me this would happen anyway). What sometimes happens is that the mum takes more leave and takes on responsibility for baby organisation and when she goes back to work, that responsibility continues. But your husband or partner is just as capable of buying diapers and thinking about dinner. Perhaps more so while you are adjusting to getting back to work. Your childcare (professionals or other family members) also need to know how to store and prepare breast milk and they need to know about paced bottle feeding techniques and the ideal way to give a bottle (have a look at ‘paced bottle feeding’ on YouTube).


 5.  Practise pumping.


Is the breast pump you are using a home something you are familiar with? Do you have a backup if you need to pump at work? It’s a good idea to use a DOUBLE electric breastpump if you can. You want one that’s robust and used to frequent use. You may be able to hire one. Watch out for used pumps as some aren’t ‘closed systems’ and milk and mould can get inside the pump and make them potentially unsafe.


There are tricks such as preparing the breast using massage and warm compresses. And we know that women who finish a pumping session using hand expression techniques can increase their output considerably.


It’s also not a bad idea to build up a bit of a freezer stash before you go back. If you start pumping for one extra session each day and storing that in a freezer bag (store them flat and build up layers of thin flat bags which defrost more easily and take up less space), you will have some wiggle room if you need it. It’s not entirely predictable how pumping will go at work and some women find that their pumping output decreases towards the end of the week and then a weekend of normal breastfeeding boosts it back up again. If you have that freezer stash, it will take away some of their anxiety.


 5.  Get your kit.


So you need a pump and some bottles and some breastmilk storage bags. What else? Surprisingly not much. You don’t need to store freshly expressed breastmilk in the fridge at work if you don’t want to. You can have a freezer block and an insulated bag and put any expressed milk in there. It is fine in that for 24 hours. So if you store it like that at work, put it in the fridge when you get home, then that milk can be given to your baby’s carer for the next day.


It’s also really important to note, you don’t need to wash and sterilise the pump between pumping sessions. Breastmilk is fine at room temperature for up to 6 hours. So you certainly don’t need to wash a pump between your 11am pumping session and your 2pm one. Lots of working mums use a technique called ‘wet-bagging’, putting a pump in a plastic bag between sessions and then putting it back in the fridge. Then simply take it out next time and wipe any wet parts with paper kitchen towel if you don’t fancy cold drips against you! This also saves precious time.


 6.  Breastfeed when you can.


Your supply is more likely to be maintained if you breastfeed when you get the chance. Is your childcare near work or home? Could you work from home for one day a week for the first few weeks? You could breastfeed early in the morning, then once more at drop-off, once more at pick-up and again at home later in the evening. Breastfeeding at the weekends and during holidays will help to boost your supply.


 Here are the stories of three mothers:

Phoebe is returning to work at 2 months. Her baby feeds around 6 times in 24 hours and a few of those are at night. She has a job where she’s often out of the office and pumping during a working day isn’t easy. She breastfeeds her baby at 5.30am when they wake up. When she gets to day care, she does a little mini-feed just to get as much milk in him as she can and then she goes to work. She pumps around 10.30am and it takes 10 minutes with a double pump. She stores the milk in a cool bag with an ice block and leaves it in her desk. She keeps the wet pump in there too in a Ziploc bag. Some days she is on a client visit and she drops by her baby’s daycare around lunchtime for a breastfeed. If not, she’ll pump again at around 1pm. She leaves work at 4pm and feeds her son at his daycare. She breastfeeds again at home at 7pm after his bath and again at around 11pm. He wakes in the night to breastfeed and Phoebe co-sleeps with him (following the recommended safety guidelines) so night feeding fits with her sleep cycles and it isn’t too disruptive. Her son’s daycare give him a bottle of expressed milk roughly every 4 hours. On days she visits at lunchtime, he gets one larger bottle in the morning and a smaller one in the afternoon. They are careful not to feed him too close to when she is due to pick him up. Because Phoebe’s baby is ‘reverse cycling’ (feeding more at night than he does in the day, he takes expressed milk less frequently in the day than another baby of the same age might).


Carla is going back to work full-time at 6 months. Her son is an enthusiastic exclusive breastfeeder and she’d like to avoid using formula if she can. When her son is 4 months old, she writes to her boss (she is a PA in a law firm) and explains she would like to express her milk at work. Her boss explains the company procedure of having a small office set aside for pumping and there is also a fridge available. Carla explains she intends to express around 3 times in the working day and one of those times will be during her lunch break. Her boss is fine with that. She has a double electric pump which she starts using from 4 months and she gives her son a bottle every other day to get him used to it. She finds he prefers to sit a bit more upright and usually takes 3-4oz from the bottle.

She starts solids around 10 days before she goes back to work and he takes small amounts initially and Carla knows his breastfeeding schedule will remain unaffected for a while. The week before she starts work, they visit the nursery together and he has a few hours there. He then has two trial days where Carla practises her expressing schedule and the daycare workers give him a bottle and some solids.

On her working day, she breastfeeds him as normal at 6am. She drops him off at daycare at 7.45am and offers again and he takes a small feed. At work she expresses at 11am, 1.30pm and 3.30pm. She collects her son at 6pm. He is keen to breastfeed when she arrives and they breastfeed at nursery. She breastfeeds him again at home at around 10pm as a dreamfeed.  He wakes once at around 2am and she breastfeeds him again.

While he is at daycare, the carers give him bottles and offer solids and he usually takes around 12oz in total while they are separated. As he has 3 good breastfeeds in addition to that in 24 hours, Carla isn’t worried. Carla expresses more milk at work than her son takes in a bottle at the moment. Over the next few weeks, she moves to expressing only twice. Carla ends up offering exclusive breastmilk until 12 months and then she gradually introduces full fat cow’s milk.


Karen is returning to work when her son is 6 weeks old. She practised expressing and giving some bottles in the 2 weeks before she was due back to work but she didn’t introduce a bottle before then. She breastfeeds at 6am. She expresses at 11am, 2pm and 5pm. She uses a double electric breast pump and stores her milk in a mini fridge. She gets around 90-120mls (3-4 oz) each time she pumps. She collects her son at 6.30pm and breastfeeds. She breastfeeds again at 9pm and 11pm (and he often wants to cluster feed in the evening. She finds that wearing him in a sling makes life easier). He feeds again at night at around 2am.


Does any of that fit with what you might do? The truth is that every story is different and every family find their own way. The months that you choose to combine working and giving breastmilk will be hard work but what part of new motherhood isn’t? And the effects of your decision will last a lifetime.


So ladies what to do you think? Got questions? Let us know in the comments section below!  To learn more about Emma, and get your hands on all her amazing articles, videos, and resources, head on over to her blog


Posted on September 17, 2015 and filed under BREASTFEEDING, POSTPARTUM.

The Dirty Little Secret About Prenatal Vitamins

Think all prenatal vitamins are equal? Think again.

Here is the truth: Prenatal vitamins...and all supplementation for that matter.....are not really regulated by the FDA.

What does that mean?

It means things can go on the shelf without any sort of review process.  So what you think is in the bottle, might not actually be in there and/or they could be tainted with extra fillers or contamination from the factory floor due to poor manufactoring procedures.

The rule that the FDA has put in place to regulate supplements is: What’s on the label should be what’s in the bottle, and if it’s not, heavy fines ensue.

But there is no one actually watching on the side of the FDA to make sure that happens. 

This verification responsibility has been put on, what they like to call, "independent watch dogs".  

The thing is though, it costs a ton of money to do this. So the majority of these independents charge supplement companies a major heavy duty fee to get tested, cleared, and given the stamp of approval. 

However, it still is not a requirement. 

Therefore we have this situation where there are many genuine companies that are honestly manufacturing high quality products, with the best ingredients possible, but that cannot afford to pay the heavy fee to get verified. Next to that are companies that are large enough that can afford the seal of approval on their high quality product. And then, last but not least, there are the bad seeds.  The ones who are not doing business for the right reasons, selling you shoddy products, and who are essentially getting away with it.

Bottom line that you need to know is: All prenatals are not created equal.

So can you trust the ones your care providers may endorse? Meh. Maybe, maybe not.

Many times even physicians and midwives don’t know how to look for high quality products because they don’t learn that stuff in school.  They’ve got people coming in their door left and right, trying to sell 'em their goods, and sometimes a health care provider makes their decision on whomever offers the best package, not necessarily on the quality standards.

So lets get savvy on how to shop for a good prenatal.  

Here is what to look for:

Seals of approval. The biggest ones being USP verified and NSF certified.  Also, look for ConsumerLab approval.  These seals mean the product has been cleared of contamination, delivers what it claims, and manufactures products in alignment with the FDA Good Manufacturing practices.

Other labeling to look for is Potency Guaranteed. This isn't exactly the gold standard, but if a company is willing to put themselves in a legal position as this, then I'm pretty certain they are confident that their products will check out ok.

Third, look for an expiration date.  Expiration dates are not required by the FDA, but any company that doesn’t put an expiration date means sketchy business to me.  There are some vitamins like B and C that have a short shelf life….so if there is no expiration date, how long do you know that bottle has been sitting there??! Not good.

Fourth, look for red flags on the ingredient list. If you see sugar, artificial colorings, preservatives, shellac or chlorine, put it back.  It means subpar quality.

Next, make sure your prenatal has the appropriate dosage:

Folic Acid should be in the 600-800 mcg range.

Iron, around 10-18 mg.

Calcium, around 400-800 mg, and should be in the forms of calcium citrate, calcium lactate, or calcium malate NOT calcium carbonate as that is the form that is the least absorbable…of course it also happens to the cheapest.

And nowadays the newer prenatals are focusing on Vit D, somewhere in the 200-400 IU range.

If you have something special going on like celiac disease or you are taking other medications it is crucial to sit down with your doctor and make sure you are getting compatable doses.  Sometimes you might need more of something, other times less than the recommended value.

If your doctor has no clue, find somebody who does.  I always think it’s worth getting their opinion.

The following list is of brands that have consistently proven their worth: GNC, New Chapter, MegaFood, Garden of LIfe, Delta Labs, Spring Valley, and Nordic Naturals. 

(I'll add here that this list is not exclusive, so just because your prenatal is not on here doesn't mean it might not be good, nor am I affiliated with any of them.)

See ya next time!



Posted on August 24, 2015 and filed under CHILDBIRTH, POSTPARTUM, PREGNANCY.

Is That After-Baby Tummy Bulge Actually A Diastasis Recti?

Smart Sexy Birth Blog

So you've had baby, you are a few months postpartum and you still feel like you look 4 months pregnant?

Or maybe you've already gotten back into an exercise routine and it just seems like no matter what you do that tummy is not going back in like it used to be?

A permanent fixture of a pregnancys toll on your body? Maybe.


There is a silent epidemic hitting postpartum women all over the U.S and it's called a Diastasis Recti, a condition where the front surface muscles of your belly seperate.  

I called upon renowned expert Melissa McElroy, PT, DPT, a trained Physcial Therapist from Bellarmine University who specializes in Women's Health and Male/Female Pelvic Dysfunction to fill us in on how to tell if you have a Diastasis Recti and what to do if you suspect it.

So what exactly is Diastasis Recti and what causes it?

Diastasis Recti (DR) is a separation of the rectus abdominis muscle (think 6-pack muscle) midline down your abdomen, causing stretching and compromise to the connective tissue surrounding it. In general, this stretch and separation is caused by continuous or chronic repetitive pressure or force on the structures/ increased tension on the abdominal wall. This occurs in pregnancy, with increased incidence into the 3rd trimester when prolonged forces against the abdomen are greater.

Image courtesy of Wendy Powell at

Image courtesy of Wendy Powell at

What problems can occur if left untreated?

One of the primary functions of the rectus abdominis muscle and its associated connective tissue is support and compression of the abdominal organs as well as counter-balancing the muscles of the back. If left untreated, a DR can lead to chronic low back pain, pelvic organ prolapse (bladder falling, uterus falling), incontinence and hernias, as well as pelvic instability and increased incidence of pain with subsequent pregnancies.

How often do you see it in your practice and why do you think it has become so common?

Almost everyone who comes into our clinic (male or female) is tested for a DR because it is extremely common. I don’t think that there is necessarily an increased incidence of DR compared to 5/10/20 years ago, but I do think that it’s finally being given the attention that it desperately deserves.

So you are saying it has always been an issue for women, but that we have lagged in addressing it postpartum?

Yes.  This is one reason why I'm seeing women who's children are older/grown who come in due to prolapse issues; because their DR was never properly addressed.

Why is there such a massive gap in screening for it postpartum?

I feel that post-partum care as a whole is lacking in the US. As a society (medical and otherwise) we shift our focus to baby as soon as he/she arrives, often forgetting that the mother’s body went through a wonderful but traumatic event to bring baby into the world.

How do you know if you have it?

There is a simple test that can be easily performed at home. It can be done on your own, but it’s highly recommended that you have a friend or significant other perform the testing instead.

The patient lies on her back with knees bent and feet resting on the ground. The tester (friend/family member) places his/her fingertips into the belly button with their hand perpendicular to the abdomen. Then the patient is asked to raise her head off the ground while reaching with her hands towards her toes.   A measurement is given based on how many fingers fit between the ridges that the abdomen makes when the patient raises her head. The test should be repeated above and below the belly button as well.

A positive DR is a measurement more than one fingertip’s width. Research is varying when determining how many finger widths should be considered “significant”. My thought is, if you’re worried enough to be testing yourself then you may just want to get things checked out by a professional.

If a woman suspects it, what should her next step be?

First and foremost, DO NOT TRY TO DO CRUNCHES. This will NOT, I repeat, will NOT help. It will most likely make it worse. If you suspect that you have a DR then find a physical therapist that treats it and go in for an evaluation.

What are some of the things that a woman should do, or more importantly, should NOT do, day to day?

Like I said before, your typical ab exercises (crunches, sit-ups, leg raises) could make your DR worse, so please don’t do them! (Obviously, if you are under the care of a licensed medical provider who is familiar and experienced treating DR and they have you performing a plank or leg lifts then maybe you’ve advanced to where its appropriate. For most of us, however, just stay away). Other day-to-day activities that you should be paying attention to are getting in and out of bed, getting in and out of a car, throwing laundry in the dryer, lifting the kids, lifting anything with weight to it. No forceful bending, raising up (like out of a recliner) or rotation. The general rule of thumb is, if your belly bulges when performing the activity then it needs to be stopped or modified so that there is no belly bulge with activity.

Is there anything a woman can do to prevent DR while she is pregnant?

Gernerally, the better core control/core strength you have prior to pregnancy and the more you work your core muscles (with appropriate exercise) during pregnancy the better off you will be. Does this mean that if you have a 6-pack before pregnancy that you won’t develop a DR? NO. Does this mean that you won’t get a DR if you work out daily during your pregnancy? Sorry, No. But you will be more apt to better rehab and recovery.

Is there an online resource a woman can use to locate therapists who specialize in treating Diastasis Recti in her area?

The American Physical Therapy Association’s Website: has a “Find a PT” page that you could search for a PT who specializes in Women’s Health. That would be my first recommendation. However, there are a lot of PTs who aren’t listed in that database, so my next recommendation would be to talk with your OB/Gyn or local general PT to see if there is anyone that he/she recommends.

Thank you so much for sharing your wisdom with us Melissa!  If you are in the Louisville, KY area and would like to make an appointment with Melissa you can find her at Dunn Physical Therapy.

For more information and some visuals on how to test and what it looks like check out:

So ladies lets spread the awareness!  Post this to your FB page through the link below and make sure all your girlfriends read it!

I want to know from you! Had you heard of DR before and did your ob or midwife check you for it postpartum?

Hugs and kisses to you all!




Posted on August 10, 2015 and filed under POSTPARTUM, MOTHERHOOD.

Motherhood Funk


The monotony of motherhood hit me pretty hard, flat out, immediately after my first birth.  I felt the funk deep in my bones from the get go.  Stuck in that beige place of "what the hell happened to me?" mode.  

Social media did not serve me well in those heavy days.  People were out saving the world, carving creations of every marvel out of their lives (or so it seemed) while I got up, changed diapers, made food, cleaned the mess, put babe down for nap, rinsed and repeated.

ALL. DAY. LONG. EVERY. SINGLE. DAY.  To this child that I had wanted yet not planned for.

And actually I shouldn't mislead you, the cleaning part happened mostly in my head.

The reality was that I was too damn tired.  Yes, on a physical note that can only be understood until you experience it but, more poignantly, I was tired in the depths of my heart.  

I was sucked dry.  Sucked by what?  That’s a good question.  

But the reality was: me sitting on the sofa looking at this babe, to then what evolved into two babes, wondering what in the hell I was doing with my life?  Was this it?  This was all that there was and ever going to be?  Was I just a fool?

So then, naturally, being a human in the postmodern era I began to say:

 “There is something wrong with me.”

"It's me that is the problem."

"I'm not trying hard enough."

“I’m broken.”

So off I go clambering to get my hands on any book, blog, state of purchased mind to make me all better. Fix me.

And it didn't.

And there I am again sitting on the couch, drenched in the funk.

No matter how much I willed myself to find grace in the little things of life, I just couldn't.  There was this unease, this restlessness, that just would not go away and it haunted me for nearly my whole first three years experience of motherhood.

Postpartum depression? I'm sure.  I thought about taking medicine a lot.  Should I have?  Perhaps.

But now my oldest son is nearly four and for the first time in my entire life I smell, perhaps ever so taste, an ease of this whole motherhood thing.

Ease perhaps is not the most fitting term.  Because it still is not easy.  It still is not natural.  But there is a Peace.  

A Peace in being a woman who is a mother to these particular children.  A Peace in being a woman who is a wife to this particular man.  A Peace in being a woman who is living this particular life, on this particular journey, in this particular moment in time.

So I wonder, what is it that makes it so different now?  What awareness have I been gifted, or at all?  It must be something good for I find the greatest Truths are the ones that are the hardest to form words around.  

They cannot be intellectualized, only quietly yet profoundly sensed deep down in the crevices of our souls, like a whisper with weight.

Perhaps I know now:

That motherhood did not cover me up but actually stripped me of my ignorance to my true state of being.  The weight of suffering was not a causation of becoming a mother, but had actually, much to my dismay, always been there.  Stepping into the role of Mother had only catapulted it to the surface, gasping for air.  Once I swallowed that hard medicine and found gratitude for it, something shifted.

Perhaps I know now:

That the worst way to get through something, is to force or fight it.  It is right that we must take responsibility for our lives but the other half of that story is that we must also let go.  Did you know that the worst thing you can do when hit by a wave is to frantically swim?  You can get so turned around in the pounding that you may end up taking yourself deeper.  The first thing to do is to let it hit you.  Roll with it, not against it.  Then you look for the light and swim towards it....often you'll find the water will take you to the surface without you even having to try. But you have to trust it first. If you cannot find the Trust in your journey you will exhaust yourself.

Perhaps I know now:

That the whole reason we call motherhood a journey is because it is.  A journey.  Filled with long roads of various terrains and seasons.  If you do not have winter, how do you know what spring is?  If you do not have darkness how can you recognize the light?  We are addicted to happiness in this era of our time.  Happiness is not the point.  Happiness hangs out in the same category as anger and pride.  You want to get to a place beyond all that.  How do you do that?  Invite the very thing in that you so despise.  Feel like rubbish? Befriend it.  Feel an emptiness with no name?  Nurse her with love.  

Be your own best friend.

What would you add?

All my love,