As a Marine who plans to continue breastfeeding after your return to work, you are supported by Marines Corps Order 5000.12E, which states that, when possible, you should have the use of a clean, secluded space with access to water in which to express your milk, and access to lactation consultants for support and education.
Overall Guidelines Concerning Servicewomen in the Navy
Marine Corps Order 5000.12E provides:
15. Support of Servicewomen With Nursing Infants
a. Servicewomen who desire to continue breastfeeding upon return to duty will notify their chain of command at the earliest possible time to allow the command to determine how best to support them and facilitate the prompt evaluation of the workplace for potential hazards.
b. When possible, the servicewoman who continues to provide breast milk to her infant upon return to duty shall be, at a minimum, afforded the availability of a clean, secluded space (not a toilet space) with ready access to a water source for the purpose of pumping breast milk.
c. The time required for breast milk expression varies and is highly dependent upon several factors including the age of the infant, amount of milk produced, pump quality, the distance the pumping location is from the workplace, as well as how conveniently located the water source is from the pump location. Supervisors and lactating servicewomen will collaborate to keep to a minimum the amount of time required for milk expression. Lactation consultants are available at the MTF to assist in this endeavor.
- When alerted to your plan to breastfeed, Commanding Officers should determine how best to support you. When possible they should ensure your use of a private, clean room for expressing breast milk, with access to running water.
- Supervisors are asked to collaborate with lactating servicewomen to minimize the amount of time required for milk expression, and to make use of lactation consultant services as needed to achieve this goal.
- Commanding officers are encouraged to inform enlisted personnel of the resources available for new mothers, including the Federal WIC (Women, Infants and Children) supplemental nutrition program.
Your responsibilities as a servicewoman with a nursing infant
Consider where, when and how you will pump and store your milk on duty, and provide your supervisor with a plan in writing before your baby is born.
- Notify your chain of command at the earliest possible time that you plan to continue breastfeeding on return to duty. Working with your command advance allows them to determine how best to support you as well as to evaluate your workplace for potential environmental hazards for mothers of nursing infants.
- Develop a strategy to schedule pumping sessions while at work. Time required for breast milk expression will depend on your baby’s age, amount of milk produced, pump quality, distance of the pumping location from the workplace, and proximity to a water source. Practical tips for efficient and effective pumping and feeding expressed milk are below.
- If a private room for nursing mothers is not already established, assess possible locations and review them with your supervisor in advance. Spaces should provide privacy, access to clean, running water, and be as close as possible to your workspace to avoid adding travel time to break sessions for pumping.
- Determine how you will store expressed breast milk. Access to refrigeration is ideal, but you may keep breast milk cool in a portable cold thermal bag if refrigeration is not immediately available. Access to a freezer compartment is necessary if your workday extends beyond 12 hours. Breast milk should be contained and labeled so as to avoid contamination by other items located in the vicinity.
Practical tips for military nursing mothers
General facts and advice about breastfeeding are available at the resources provided above, from lactation consultants and breastfeeding classes at your hospital, online and in many popular books. Overcome special challenges you may face as a nursing mother in the military by doing your research and being ready to answer these important questions:
How will you express and store your milk?
- While you are on leave, exclusively breastfeed your baby from birth forward to establish lactation, build your milk supply, and give your baby the healthiest start possible. In the third week post-partum, or when your doctor advises, begin learning to use a breast pump. Practice using your pump early in the morning, before your baby wakes up and nurses. You will find it easier to produce milk early in the day, and your baby will still obtain all the milk he or she needs when he nurses. Milk expressed during these practice sessions can be frozen and saved for use on your return to work as a back up supply in addition to the milk you express while on duty. If you are able to express and save 2 to 3 ounces a day beginning the third week of your leave, you may be able to return to duty with 40 to 60, or more, ounces of milk in your freezer for days when your baby needs an extra snack or if you must work late or overnight.
- When you return to active duty, you will find that the number of breaks needed to express breast milk is greatest when your baby is six months or younger. When your baby begins to eat solid foods around six months, the daily amount you express and frequency of pumping will decrease. Between six weeks and six months after birth, expect to pump for 15 to 30 minutes every 3 to 4 hours to maintain lactation and obtain sufficient milk for your baby while you are at work. Overall, plan to pump or nurse your baby at least 8 times every 24 hours until your baby begins eating solid food in addition to breastfeeding. If your milk production seems to be decreasing, increase the number of times you pump or nurse each day until you are again producing as much milk as you need.
- The amount of expressed milk you baby needs will vary as he or she grows and depending on the length of your workday. Over an 8-hour workday, your baby may need 12 ounces. If you pump 6 to 8 ounces in a morning session and 4 to 6 ounces in the afternoon, and another 2 to 4 ounces at the end of the day, you will have 12 to 18 ounces of fresh milk for him or her the following day. If he or she seems to want more, add a pumping or nursing session to your schedule to increase your supply. Sessions early morning and in the middle of the night will be most effective.
- Keep your baby near you at night so that nighttime nursing is convenient and restful. Babies of working mothers tend to want to nurse in the middle of the night and sometimes sleep more during the day when mom is not there. Lactation consultants call this pattern “reverse cycle feeding” and consider it a healthy adjustment a baby makes to his or her mother’s schedule. If your baby begins to reverse his or her cycle when you return to duty, let him or her nurse lying down with you at night. You will both rest and doze while he or she gets a heaping helping of milk and mom, and your milk production is given a solid boost.
- Make your pumping sessions at work as efficient as possible. A “hospital-grade” electric double-sided pump will express the most milk in the shortest amount of time. These pumps are expensive to purchase and can be rented from lactation consultants and pharmacies. High quality electric pumps mimic your baby’s nursing rhythm, and so help you express more milk more quickly, and maintain your milk supply despite regular separations from your baby. These pumps can be shared by several users, as long as each user has her own set of tubes, flanges and collection bottles. A shared high-quality pump left in a pumping room can be a real convenience for units with several nursing mothers. If you prefer to purchase a single-user pump, buy the best electric double pump you can afford from a manufacturer that specializes in breast pumps and breastfeeding supplies. Poor quality pumps can damage your breasts and allow your milk supply to dwindle.
- If you are likely to be on training exercises or in other conditions that do not permit use of an electric pump, learn to use a simple portable hand pump that can be rinsed and stored easily. With a little practice, many mothers find they can obtain as much milk from a hand pump as from an electric pump. Short-term use (one to three days) of a hand pump will not impact your long-term milk supply. Practice expressing by hand as well. Some mothers become quite adept at hand expression and give up pumps altogether. Every mother, however, needs to know how to hand express enough to avoid engorgement.Military moms, however, must know how to use a hand pump or express by hand to have the flexibility to perform your duty, no matter the location, electrical supply, schedule changes, or other unexpected circumstances common to active duty.
- Store expressed milk in bags designed for breast milk storage or food containers made of clear (not cloudy) plastic. If you use bags, place them inside another container to protect them from puncture and leaking. Breast milk is a very stable substance and can be safely stored at room temperature for up to four hours. Refrigerated milk can be kept for up to eight days. Frozen milk keeps for several months. Exact guidelines for safe storage and use of expressed milk can be found at: http://www.cdc.gov/breastfeeding/recommendations/handling_breastmilk.htm
- If you work in an environment in which you are exposed to hazardous chemicals, you may need to dispose of the milk you pump rather than save it for your baby. It is still worthwhile to pump, however, to maintain milk production when you are not with your baby.
- If you are deployed or away from home for more than 24 hours, you can freeze your expressed milk and store it or, if packed with freezer packs and insulated, ship it home to your baby’s caretaker via overnight delivery.
Where and when will you pump?
- If your unit does not have an established lactation program and dedicated space for nursing mothers, you may need to be creative and flexible to find a clean and private place to express milk. Servicewomen have used empty offices, conference rooms, exam rooms, supply closets, and even bathrooms. Work with your Commanding Officer (CO) or supervisor during your pregnancy to identify a location that is convenient to your post and offers access to clean, running water. Access to a refrigerator is ideal, but not necessary if you have an insulated bag in which to store your breast milk.Communicate to your CO that the more convenient and private the location, the less time you will need for breaks to pump.
- You will be advised by most breastfeeding manuals to avoid pumping in a bathroom, as breast milk is food for your baby and you wouldn’t want your own lunch prepared in a bathroom. That is good advice, but your choices may be more limited than those of civilian nursing mothers. Your best option may be a private bathroom with clean, running water to rinse your pump attachments. In nontraditional jobs, you may not even have that. Resourceful servicewomen in flight or field operations, or on patrol or guard duty or onboard ships have found ways to express their milk. With sufficient practice with a portable hand pump, you can express milk in the back of an ambulance, or in a tent, or even under a poncho.
- The key to pumping in stressful and changing environments is to condition your letdown reflex to the pump. When your letdown reflex occurs, your breasts release high fat milk in quantity (you can see the color of your milk change from a thin, bluish-white to creamy white). Stress inhibits the letdown reflex, however. By thinking about your baby, no matter what is going on around you, you will begin to associate your pump with your baby, and your letdown reflex will respond. Tuck a picture of your baby and small shirt your baby has worn recently and still carries his scent in your pack. Take them out along with your pump to help you focus on your baby and let your milk flow in any environment.
- Active duty schedules can be unpredictable. Your 8-hour day may suddenly become a 12-hour day, or overnight. Your shift may change from day to day. You may find yourself in field exercises or flight duty for several days. You may be deployed. While pumping on a schedule of every three to four hours is ideal, you may need to pump whenever you get the chance. Balance an unpredictable pumping schedule at work with lots of nursing your baby when you are at home. Nurse when your baby wants, rather than according to the clock, and as long as your baby wants when you are together to maintain your milk supply and continue breastfeeding.
How will you build acceptance for breastfeeding among your CO, supervisor, and unit?
- Military readiness is you and your CO’s first priority. This toolkit provides the data and insights that link successful breastfeeding with key factors that enhance military readiness: retention and morale of skilled servicewomen, physical fitness of servicewomen, reduced absenteeism due to infant illness, and reduced health care costs for military families and TRICARE. Communicate these factors to your CO and supervisor as you create a plan to continue breastfeeding while on active duty.
- The Marines support active duty servicewomen who continue to breastfeed. Learn how current policy (summarized in this toolkit) instructs COs to support you, so that you can be relied on by your unit as an informed resource. All branches of the Armed Services are committed to aligning their policies with the Surgeon General’s Call to Action to Support Breastfeeding 2011 and federal objective Healthy People 2020.
- Create a written plan for your CO and supervisor that will show how you will integrate milk expression and storage with your duties. Detail your suggestions for a private, clean location. Draw up a schedule that shows how you will manage your assigned duties with 15 to 20 minute breaks every three to four hours. Be detailed and flexible so that your CO knows you have considered all aspects of the process.
- Unpredictable schedules and other aspects of active duty, including backpacks and heavy gear, can put you at risk of engorgement or plugged ducts which can lead to mastitis, a bacterial infection of the breast requiring rest and antibiotics. Explain to your supervisor and unit that taking brief breaks to express milk is essential to keeping you physically fit and on duty.
- Breastfeeding supports your return to physical fitness after pregnancy as calories used to produce milk reduce pregnancy weight. Take care to lose no more than one pound per week to avoid decreasing milk production. Be sure to stay well hydrated, wear a supportive bra that does not press on and block milk ducts, and nurse or pump before exercising to prevent mastitis.
- If you face criticism or other negative responses from others in your unit, stay focused on the reasons you continue to breastfeed. Objections will lessen and even vanish when you demonstrate that you can perform your duties while meeting your baby’s needs.
- Remember and communicate to your unit that breastfeeding and pumping are temporary. The early months in which your baby is exclusively breastfed, ideally from birth to six months, go by quickly.