Am Fam Physician 2003;68:2201-8,2215-7.
Mothers who work outside the home initiate breastfeeding at the same rate as mothers who stay at home. However, the breastfeeding continuance rate declines sharply in mothers who return to work. While the work environment may be less than ideal for the breastfeeding mother, obstacles can be overcome. Available breast pump types include manual pumps, battery-powered pumps, electric diaphragm pumps, electric piston pumps, and hospital-grade electric piston pumps. Electric piston pumps may be the most suitable type for mothers who work outside the home for more than 20 hours per week; however, when a mother is highly motivated, any pump type can be successful in any situation. Conservative estimates suggest that breast milk can be stored at room temperature for eight hours, refrigerated for up to eight days, and frozen for many months. A breastfeeding plan can help the working mother anticipate logistic problems and devise a practical pumping schedule. A mother’s milk production usually is well established by the time her infant is four weeks old; it is best to delay a return to work until at least that time, and longer if possible.
Exclusive breastfeeding for the first six months of life is recomme nded for most infants, followed by breast milk supplemented with solid foods for at least the rest of the first year.1,2 Although breastfeeding rates in the United States have improved, they remain below the Healthy People 2010 goals (Table 1).3,4 As of January 2003, 60.7 percent of women are working outside the home, and women comprise 46.5 percent of the civilian work force.5 While working outside the home does not affect the initiation rate for breastfeeding, it does affect the duration of breastfeeding3,6 (Table 2).3
To achieve the Healthy People 2010 goals, family physicians and other health care professionals should provide encouragement, advice, resources, and support to help mothers continue breastfeeding after they return to work. During an early prenatal appointment, the physician should ask the pregnant woman whether she intends to work outside the home after the birth of her infant. Another time to discuss work plans is at the two-week or one-month well-child check-up. If a mother intends to return to the work force, the family must begin making plans. Hence, education about community support, breast milk pumps, breast milk storage, and breastfeeding planning should be given as early as possible.