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Breastfeeding and returning to work? Join the online Working Mothers Conference on 6 February 2021 and prepare for your return. From expressing your milk to SA law, we've got you covered to make the transition as smooth as possible. HeartFM Radio 00:00 / 00:34 Working Mothers' Breastfeeding Conference Saturday, 6 February 2021 | 09h00 - 13h00 Returning to work? Not sure how you can continue to breastfeed while working? Not sure how to express, or how much milk to leave for baby? Worried about your milk supply? THIS ONLINE CONFERENCE IS FOR YOU! Join La Leche League South Africa at the Working Mothers’ Breastfeeding Conference for information shared by real-life working mothers. Our online session will cover the following topics: SESSION TOPICS INCLUDE The importance of breastfeeding for babies, mothers and their employers South African law and your rights Working Full-time, Part-time, From or Away from Home What to look for in a caregiver Preparing for your first day back at work Different types of pumps and how to use them Hand expressing Encouraging baby to take a bottle Different ways of feeding your baby How to store and handle breastmilk What to do if your supply drops Practical ideas to make working-and-breastfeeding "work" Sessions are presented by La Leche League Leaders who are working mothers Information is evidence-based and supported by science Working-Mother eDownload information pack WORKING MOTHERS CONFERENCE PACKAGE | R180 BOOK YOUR TICKET NOW THROUGH QUICKET Meet our speakers RAHMAT BAGUS Rahmat is a La Leche League Leader from Cape Town. She is a medical doctor and has been a working breastfeeding mother with all 4 of her children. With her first child, she used formula milk as well as expressed breast milk when she returned to work. With the latter three children, she exclusively breastfed until her children started solids. All of her children have breastfed for extended periods of time. LEANI KHAN Leani changed her mind about returning to work after her first child was born. She now has three children and over the years has experienced different work options. She has at times been a stay-at-home mom; at other times she has worked part-time, and full-time. She has been able to negotiate creative solutions with her employers in order to be more available to her family. GWYNNETH JACOBS Gwynneth is a biological scientist working full time in a government laboratory. She credits her parenting success to the support and information she received from La Leche League South Africa, which helped her exclusively breastfeed and express after maternity leave. As a result she became a Leader and has supported other working mothers in her workplace and beyond. She is currently expecting her second child and is still nursing her firstborn. She plans to express again upon returning to work. AMOR HERBST Amor is mother to three school-aged girls which includes a set of fraternal twins. Having struggled with breastfeeding her firstborn, Amor joined La Leche League South Africa after the birth of her twins for support and evidence-based information. Amor managed to combine working full-time in the I.T. industry (and expressing her milk at work) with caring for her family and reaching her breastfeeding goals. GWEN BRITTEN Gwen is a medical doctor who suprised herself by staying home with her first born child. She now has two boys and does locum work to try and find a balance between being available to her small children and earning a living. Both her children have breastfed for a lengthy time, and La Leche League has been an important part of her support network in managing to do this. LEANA HABECK Leana became a La Leche League Leader shortly after the birth of her third baby. She resigned from her job to be a stay-at-home mom during her first two children's younger years. By the time her third baby was born she was working flexi hours. Among her many other commitments she is still running a busy clinic as an International Board Certified Lactation Consultant. It was only with amazing support from family, friends and La Leche League that she could overcome many of the obstacles working and breastfeeding mother-baby pairs face. All three her children were exclusively breastfed. TERCIA MOSES Tercia is a stay at home mum to 3 busy children. She has spent several years as an Educarer in a childcare environment and 3 years as a Unit Administrative Assistant. Tercia decided to resign from her job after the birth of her second baby to meet the needs of her growing family. She is still breastfeeding her children. Don't miss this fantastic online conference Tickets for the La Leche League South Africa Working Mothers Conference are available on Quicket . For more information contact info@lllsa.org

My breastfed toddler's skin has turned orange / yellow! Is it my milk? Read more about carotenemia here. MY BREASTFED TODDLER’S SKIN HAS TURNED ORANGE / YELLOW! IS IT MY MILK? Most likely, your toddler is experiencing carotenemia, a condition most often found in babies and toddlers, where skin, especially parts that tend to sweat a lot, becomes tinged with orange. It is most visible in babies and toddlers with light complexions. The condition is caused by ingesting a large amount of carotene, a nutrient most often found in human milk, carrots, squash, sweet potato, pumpkin, spinach, beans, egg yolks, corn and yams. Note that most of the foods listed fall into the “yellow vegetable” category. Cooking, mashing, or pureeing foods increases absorption of carotene (Leung, Alexander. Carotenemia. Advances in Pediatrics. 34: 223-248. 1987). Human milk is also full of carotene, and can even become yellowish or orange if a mother eats a diet high in the foods listed above. The good news is that carotenemia is nearly always a harmless condition (there are some rare diseases that also cause the condition, so if your child is showing signs of illness, you may wish to consult a health care practitioner). Carotenemia is not associated with Vitamin A poisoning, even though carotene is converted to Vitamin A during the digestive process, because the conversion is slow. The easiest way to avoid this issue is to follow La Leche League’s standard dietary advice for both mother and child to eat a wide variety of foods in as close to their natural state as possible. Sometimes toddlers go through “phases” of only liking one type of food, such as carrots, which might lead to carotenemia. As long as the toddler is also breastfeeding, which means getting complete nutrition, these phases can be tolerated in moderation. Continuing to offer enticing, yet nutritious alternatives will usually result in moving on to a new favourite taste in a short time. The Womanly Art of Breastfeeding has helpful information on introducing new foods and encouraging healthy eating habits. *Parts of the contents of this page was generously supplied by La Leche League International

Sleepy babies who feed infrequently and don’t gain weight – the risks of pacifier use in the early weeks An LLLSA Leader was approached by a mother with concerns that: Her 3-week-old baby struggles to wake up to breastfeed. He easily goes 3-5 hours between feeds. This was causing her to become painfully engorged. She had tried waking him up, tried skin-to-skin contact as well. She had even tried expressing some milk onto his lips before latching to entice him. When she does put him to the breast, he cries and fusses or doesn't seem interested in feeding at all. The crying was causing her a lot of distress. The Leader gently asked the mom how she soothed her baby when he cries and is upset. The mother shared that she panics completely as she isn't sure how to soothe a baby, so she desperately pops a pacifier in his mouth and that he then sucks himself to sleep and stops crying. The LLLLeader explained some practical and physical ways to soothe a baby, including breastfeeding. Over the conversation the mother wondered if the pacifier was likely hiding hunger cues and making baby sleep through breastfeeding sessions. She decided to try to stop using the pacifier and resolved to attempt to soothe the baby with her breasts and with gentle rocking, swaying and singing. Three days later she reported back that her baby’s schedule had changed entirely. He was now breastfeeding every hour and a half to two hours, not sleeping extra-long stretches, spending more time awake than he used to and her mothering felt more natural and intuitive. Her breasts were also no longer painfully engorged. The baby’s nappy output and poops had increased. ******* The Womanly Art of Breastfeeding (WAB) offers an explanation for this very common newborn behaviour: Sucking on a pacifier releases a hormone called CCK. A baby can fall asleep with a pacifier, thinking she’s been fed. But really, she’s been fooled out of a meal, and your breasts have lost a feeding’s worth of milk removal. Result: slower weight gain and lower supply. Excerpt from WAB about CCK, 8th edition, pg. 107: If she (the baby ) has fallen asleep nursing (breastfeeding), it’s partly because her level of cholecystokinin (CCK) has risen. In a newborn, a high level of this hormone makes a baby sleepy and tells her that she’s full; a low level can wake her and tell her she’s hungry. After maybe twenty minutes of sucking (not necessarily eating ) your baby’s CCK has risen enough to put her to sleep and give her a rest from all her hard work. About twenty minutes after she’s stopped sucking, her CCK level has fallen again. Your baby may wake up (HELP! STARVING BABY!), convinced she’s never eaten before in her life, giving her a chance to “top off her tank” with renewed energy. Another sucking bout, another CCK rise, and she’s likely to zonk out completely. CCK is a marvellous arrangement that keeps your baby from working too hard for too long but also acts as an alarm clock to give her a second or third (or fourth) chance if she needs a little more. And it allows a new and inefficient baby to come back for seconds and encourage your new milk supply—part of a system that helps ensure enough food for the baby, enough production from Mama. Sucking on a pacifier releases CCK, too. A baby can fall asleep with a pacifier, thinking she’s been fed. But really , she’s been fooled out of a meal, and your breasts have lost a feeding’s worth of milk removal. Result: slower weight gain and lower supply. CCK is Nature’s way of helping to make sleep happen and keeping your supply strong. Why mess with such a well-designed system? Save yourself a lot of effort, nurse (breastfeed ) the baby one last time, and odds are she’ll start to snooze.

My second child, my son, was born on 2 September 2021 after an emergency C-section. He arrived unexpectedly at 32 weeks, weighing 2.1kgs. For the first 24 hours he was in the NICU on oxygen, and I couldn’t see him, but I was advised that breast milk is the best for his development and I should start expressing immediately. The first attempt at expressing my milk involved a nurse hand expressing and catching the milk in a 5ml syringe. I think I got around 2ml of colostrum and the nurse thought it was amazing. At 32 weeks my son needed very little, and every drop helped. They also requested donor breast milk, as they didn’t want to top him up with formula if I wasn’t going to produce the volumes needed. I loved that, as I was always an advocate for breastmilk. For that first day after my son was born, I couldn’t see him or hold him, but my body was doing what it needed, and with the guidance of the nurse I was hand expressing every 2 hours. Expressing every 2 hours was very stimulating to my breasts and I could notice that my milk production was increasing. By the time I was discharged 4 days later, I was using an electric pump, and I was getting about 60ml at each pumping session. I was now able to hold my baby, but he was still only being fed my breastmilk via a feeding tube. My body was doing what my baby needed even without the stimulation of baby’s mouth on the breast. When I was discharged, I stuck to a 2.5 hourly pump routine. I would do my last pump around 11pm and then wake up at 4am to start my daily routine of pumping. In the beginning I would combine milk from 2 pumping sessions into one bag/container. I would take about 4 full bags of breastmilk to the hospital. At about week 2 I was told that my baby had enough milk at the hospital, and I shouldn’t stop expressing but should start freezing my expressed milk. Two weeks after the baby’s birth we started trying to get him to latch. That was a challenging process; being premature his sucking skills weren’t fully developed. Because of Covid protocols and NICU protocols I was only allowed to be with my baby for part of each day. I would come at 8am, try to get him to feed, leave at 9am, come back at 11am, leave again at 12pm, come back at 2pm and leave at 3pm. I would then go home to my 4-year-old at that point who also needed my love and attention. When I wasn’t at the hospital, the nurses would try to give him a bottle with my breastmilk. This was a concern to me, as I was worried that he would prefer the bottle and maybe reject my breasts, but that wasn’t the case. The doctor was happy with my son’s development but indicated that baby would only be discharged when he could drink a full feed from bottle or breast and maintain his weight. After 3 weeks in the hospital my baby was latching and feeding successfully from breast with some top-ups by bottle and then he was discharged. When I got home, I followed the hospital routine of feeding every 2 hours. At this point my breasts were producing more than my baby was drinking so I would pump for 10mins after feeds if there was time. I managed to fill a 5 litre container with bags of 180ml breastmilk. I was super proud of the quantity of breastmilk I had in storage as I knew I would be going back to work when my baby was 5 months old, and I wanted to continue with exclusive breastmilk feeding for 6 months. But pumping and breastfeeding was time-consuming and exhausting and I gradually stopped pumping and was just breastfeeding. Even though my baby took a bottle in hospital I never gave him breastmilk from the bottle after that, as we were never apart, and I still feared that he might prefer the bottle. When I first went back to work after maternity leave, I didn’t go directly to the office. I was on a work-from-home basis and that allowed me to continue to breastfeed my baby on demand. I did however start introducing the bottle again. I would take milk from my freezer supply, give it to him in a bottle and then pump to replace that milk. When my baby was 7 months old, I started going into the office for 50% of the month. He would then go to my mother-in-law for every 2nd week. Here he was on solids and on breastmilk. He would drink about 3 x 120ml breastmilk from the bottle and would breastfeed when we were together. Around 8 months I noticed a drop in my milk supply. I was at the office every 2nd week where I would pump for 2 x 30mins sessions with 3/3.5 hours between sessions. I contacted La Leche League as I was concerned because I was no longer able to pump the same quantity as before. I was advised that the breastmilk baby was receiving was sufficient as he was also on solids. I wondered if he needed to be topped up with formula milk, but La Leche League assured me that wasn’t necessary. I followed their guidance and continued to pump and give baby whatever I could while apart and breastfeed him when I picked him up. That system worked well for us. Even during the Ramadan (month of refraining from food and water from dusk to dawn) I would have thought my milk supply would drop, or I would feel super drained breastfeeding while fasting but that didn’t happen. God created us to feed our babies, thus breastfeeding fits into every situation life throws our way. I attended an online workshop presented by La Leche League on breastfeeding while fasting in the Ramadan. They suggested foods that help with milk supply and how to manage the demands of Ramadan. When my baby reached 1 year old, we still had a good breastfeeding system but I noticed my son was drinking a lot, and I wondered if my breastmilk was insufficient. I reached out to La Leche League again. They reassured me that as long as my big boy is drinking, he is extracting the milk he needs, and my body will replenish the milk. At this point it became a struggle to keep up with pumping at work. When my boy was about 15 months I decided to stop pumping at work as by then breastmilk wasn’t his main source of nutrients. At the suggestion of La Leche League I began to offer him more water and solid food. Breastfeeding was also challenging at times. Baby would usually sleep in my bed and drink 2-5 times during the night. I felt like a pacifier at times, as I thought he was sucking to soothe himself, not because he was thirsty. I also got an infection in one breast; doctor said some bacteria from baby’s mouth must have gone into my breast. It was extremely painful. My breast was full and red, and the doctor suggested I should pump out the milk and not let my baby drink from that breast. (LLLSA comment: Mastitis or breast inflammation is not a contagious condition and frequent breastfeeding helps to reduce inflammation in the breast.) Around 17 months I no longer had any stored breastmilk and was no longer expressing. I started baby on a growth milk, but that didn’t work well. I don’t think he liked the breastmilk replacement and soon he was completely off the bottle, but still feeding on demand from the breast. Around this time, I had started a new job that was extremely demanding. At this point I felt I needed to start weaning baby off night feeds so I could get a better night’s rest. We started with removing the middle of the night comfort feeding. He would fall asleep on the breast, and then when he woke up my husband would try to get him back to sleep. If he woke up any time after 4am, I would give him the breast but not before that. By day 3 that routine was working well. I tried my best to do a gradual wean. I then dropped the falling asleep on the breast and eventually we were only on day feeds. That was when my breast started getting painful and full and very uncomfortable. I started with expressing in the morning to relieve the buildup during the night, as I was always leaking during the night. I then decided to remove him completely to start drying up my milk. I again looked to La Leche League for guidance. I note that they encouraged me to continue to breastfeed. It was rather sad and emotional to end my breastfeeding journey, but I believed it was the right time. At first, I needed to pump briefly to relieve my breast, as it was full and sore. By week two I didn’t need to pump but I did still have milk. My breast would leak, especially when pressure was applied like picking up baby or laying on my breast. By week three my breasts were a lot softer and there was no more leaking. I think it was around that point my milk dried up. I loved my breastfeeding experience with my son. I am super proud of my commitment. I always encourage other moms to breastfeed; it’s easier than having to pump, it’s easier than having to wash bottles all the time and it’s cheaper than buying formula milk. But mostly it’s healthier for baby, and it’s a wonderfully bonding experience. Moms, you can do this!!! Kashiefa Kalam (Dec 2023)

I am a full-time working and breastfeeding mom. I must admit that it has been a very challenging journey. With my firstborn, I went back to work when she was just under 3 months. My milk supply was excellent for the first 4 months but once she started eating, it took quite a dip. I remember being very stressed at not being able to express the amount of milk she was used to receiving and needed. I tried to pump milk, but the type of work I did made this difficult. I am sure most mothers would share the same feeling. I decided to push for as long as I could with expressing at work, which was about 1 year, and then decided to let her eat and drink tea/water bottles during the day until we would reunite at night for her feeds. It went well and the transition was easily received by her but my mommy guilt at not being able to express milk for her to take to crèche was heart breaking for me. I would watch my colleague express bottles (her baby was the same age) and then realised my milk supply was so low because I was expecting my second child. This did not stop my first born from drinking her milk at night!  (The Womanly Art of Breastfeeding, pg 277: “Your baby won’t starve while you’re at work. Your baby can get those daytime feedings in during the evening and nighttime hours instead if he prefers, in a pattern called “reverse cycling.” Night nursings (breastfeeds) are a big help to every working mother’s milk supply, especially if your baby doesn’t eat much while you’re at work.”) With my second born, I changed jobs and went back to work when she was 2.5 months old. This job and breastfeeding was and is still so challenging for me. I remember scrolling through posts on social media while on maternity leave, where moms were asking about traveling and breastfeeding and I did not pay much attention because I was not there yet. However, when my daughter was 5 months, I needed to go to Durban (from Cape Town) for a day meeting and I thought it would be easy (little did I know). I had to pump nights (midnights) in advance when my milk supply was at its peak to get enough milk to make sure my daughter had enough milk for when I was gone. It was no joke and I take my hat off to mothers who do it frequently. And now I find myself in the same situation, but my nerves are wearing thin because I need to go away for 6 days in August and 6 days in September. My second born is now 7.5 months. I have enough freezer stash to last her for the 6 days that I am away, but now I am stressed about how to transport breastmilk. (LLLSA comment: Expressed breastmilk can be kept in a fridge for a week or a freezer for 6 months. Cooler boxes can be used when fridges are not available with frequent changing of the ice bricks/blocks. https://laleche.org.uk/taking-expressed-milk-on-airline/#:~:text=It%20must%20be%20in%20liquid,accompanied%20by%20the%20breastfeeding%20infant .) I was told by the pharmacist that I am not allowed to breastfeed when I come back as I need to continue my malaria tablets; however with the amazing support and reliable assistance of our La Leche League breastfeeding community, I can rest assured that I can feed her upon my arrival because the meds are safe to take while breastfeeding. But now my stress starts because I will need to go away again in September, which means a lot of midnights. My manager has been very accommodating with regards to shortening my travel time as much as is possible, which I am so thankful for.  [LLLSA comment: for medication safety and compatibility with breastfeeding, have a look at e-lactancia.org ] I am a proud believer and advocate of breastfeeding and its natural properties. Everytime I feel like giving up, I remember how blessed we are to be able to give our children milk they need at any given moment.  Thank you to the Parow LLL Whatsapp group for always being available. We are truly appreciative of all the support. Without you all, I would have given up long ago. Written by Saajidah Lagkar, physiotherapist, and breastfeeding mother - July 2017

This is a story of how I went from formula feeding and a C-section with my first baby, to a vaginal delivery and breastfeeding my second baby. The decision to breastfeed or formula-feed is a very personal and often a very difficult decision to make in the fast-paced world we live in. My journey as a mother took me from formula feeding my first child to successfully breastfeeding my second. When I became a mother for the first time, I chose to formula-feed my baby. At that time, I was unsure about breastfeeding due to a lack of knowledge and support. Formula feeding seemed like the easier option - I mean anyone could feed her. As time passed, I began to educate myself about breastfeeding. I learnt about the benefits for both the baby and the mother, including the bonding experience it creates between mother and child; which is why I wanted to breastfeed my second child.  For the first baby, I was not educated on birthing experiences or breastfeeding. When I went into labour, I followed the common practice of rushing to the hospital when my water broke. After a night with a monitor restricting movement (I laid on my back for those 11 hours in hospital) my gynaecologist informed me I was 2 cm dilated. An hour later, with no further dilation, I had a C-section and birthed a beautiful baby girl. When my first baby was just over one year old, I fell pregnant with my second. This time, motivated to breastfeed and have a vaginal delivery, I researched and found that exercise during pregnancy, eating dates, and drinking raspberry leaf tea could be helpful to achieve this kind of delivery. I learned that immediate hospital admission during labour could increase the chances of a second C-section. When the day came, I went into labour at midnight. I began monitoring contractions. As they intensified, I moved around to ease the pain. We left for the hospital when I felt the contractions were close in time. Upon arriving at the hospital, I insisted on monitoring the baby's well-being without restricting my movement. I walked, lay on my side, and used seated positions to aid dilation. The nurse checked and found I was 5 cm dilated, but my water hadn't broken. My gynaecologist arrived, broke my water, and suggested an epidural. An hour later, feeling the need to push, I didn’t make it for the epidural and was 10 cm dilated. Then our baby girl was born. After the vaginal birth, even with tearing, I could immediately get up and I could pick up my older daughter. Contrastingly, with my C-section, it took time to move at all and caused discomfort. This time, our baby girl was put onto me immediately for breastfeeding, unlike the C-section where they took her away for monitoring and checks first and then only brought her to me after I was done with observation. With my first daughter, breastfeeding was excruciating, and I struggled with pain and latch issues. Since I couldn’t navigate further, I eventually gave up and switched to formula. For my second birth, I prioritised the first 20 minutes post-birth in hopes of encouraging breastfeeding success. These 20 minutes are known to be important as babies tend to be more alert during this time, which promotes breastfeeding success. It has also been shown that placing the baby on the mother's chest immediately after birth has many benefits to promote breastfeeding success. Skin-to-skin helps regulate the baby's body temperature, heart rate, and breathing, and it can also lead to better breastfeeding outcomes. Skin-to-skin contact stimulates the release of oxytocin, a hormone that facilitates bonding and milk production. It also helps the baby's natural instinct to breastfeed, leading to earlier initiation of breastfeeding. Research also indicates that large amounts of oxytocin are released during vaginal delivery, encouraging breastfeeding. Successfully breastfeeding my second baby was a completely different experience. It was challenging at first; I often struggled with buy-in from family because everyone had concerns about milk supply and whether I was managing. I also struggled with latching and engorgement. I had difficulty with the fact that I could not just leave my baby with anyone because she was breastfed. However, this time it was easier because I was knowledgeable, I knew who to ask for assistance and to trust my gut.  Breastfeeding my second child was not just about nourishing her but it was a journey of empowerment which has shaped me as a mother. Understanding both experiences, I believe in the importance of personal choice, empowerment, and knowing your options.  Regards, Amiena Badroodien