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	ask the experts elizabeth hormann

Elizabeth Hormann Ed.M, IBCLC
Breastfeeding, Counseling

• Thawed milk
• Decreased mlk production

I abundantly produce breastmilk, so I store lots of if it. My daughter is now two months and I have about 70 bags of breastmilk in the freezer (most of them are over five ounces each). I also have ten bags of colostrum frozen. My husband accidentally left the freezer open over night (for about 14 hours). Do you think it is OK to give my daughter the milk and /or colostrum?

What a dilemma!  Mother's milk and colostrum are liquid gold.  It's hard to even think about discarding them, but if they have been thawed they need to be used within 24 hours.  Thawed milk should not be refrozen.

Depending on the type of freezer you have, it might just be possible that some of the bags did not thaw out while the freezer door was open.  If they are still solidly frozen they can be kept. The rule of thumb is: Solidly frozen milk will keep three to four months in a separate freezer unit that is part of a refrigerator,  and at least six months in a deep freeze if the temperature stays at 0° F (-19º C) all the time.

Rather than discard thawed milk that still smells fresh, you can keep it a day or two in the refrigerator and add it to your baby's bath and to yours.  It's wonderful for the skin.  More adventuresome families might like to try using it in cooking instead of bought milk.

As disappointing as it is to lose all that milk,  the good news is that having collected more than 10 quarts of milk in two months, you can quickly have a good supply stashed away again—or if you'd like to reduce the excess a bit you can slow down on the pumping.

I am nursing my one year old son.  Just a month ago my period resumed. Since then, I've have noticed a drastic reduction in the milk produced while pumping at work.  What can I do to get the supply back up so I can continue nursing my son? I'm afraid I will run out of milk for his caregiver to feed him while I work Monday-Thursday, nine to five. I have no problem with supply while I'm actually nursing, just a problem with the supply while pumping at work. Could it be stress related? (I'm divorcing) Could it be related to birth control pills (I just started taking them one month ago but since the milk decreased, I decided to stop taking them as of today).  Any suggestions?  I do not want to stop nursing or providing him with milk while I'm at work.

Pumping is a very different process to feeding at the breast.  It's hard to cozy up to even the best of pumps and many women find that their let-down doesn't work quite as well when pumping as it does when they are breastfeeding.  This is especially true for long-term pumping.

Stress can inhibit the release of oxytocin and make it more difficult to let your milk down.  Stress can be on-going (global) or short-term (situation-related).  Since you apparently have no problem with your let-down when your little boy is at the breast, it is unlikely that the on-going stress of your divorce is causing the difficulty.

Progestin-only oral contraceptives, should not (in theory)  interfere with milk production.  Nevertheless the World health Organization (WHO) recommends waiting for six or eight weeks after birth, until breastfeeding is well established, before starting progestin-only birth control.  This is generally considered to be compatible with breastfeeding but some mothers continue to report that their milk supply declines when they use this kind of oral contraceptive.

Combination (progestin and estrogen) pills have frequently been associated with reduced milk production.  For this reason, WHO recommends waiting at least six months after birth to start on this kind of oral contraceptive. Even the low-dose combination "mini-pill" may cause a decline in milk production and shorten breastfeeding—especially if milk production has already been on the low side.

If you want to continue providing your son with your milk for the times you are away, you might consider doing some of the pumping at home and freezing the milk.  Some babies don't mind if you pump on one side while they are at the other breast—but expect a one-year old to be very curious about what's happening on that other breast.  If he objects or it interferes with breastfeeding, you'll want to find some other times to pump.

Having a second look at the conditions for pumping at work might yield some useful insights.

• Do you have enough time to relax, have your milk let down and empty the breasts?
• Are you able to pump at least twice in an eight hour work day?
• Do you have enough privacy?
• Do you have enough support from your employer and your colleagues?

Sometimes the support a nursing mother has had for pumping at the work place erodes as the baby gets older.  Have you been able to present your case in a way that your employer sees the advantages for the company or institution where you work?  There is good research indicating that breastfeeding mothers miss much less work time because their babies are ill less often.

Finally you might want to re-evaluate how much milk your baby needs when you are not at home.  If he is eating a good variety of other foods, he might do fine over the day with less breast milk than you have been providing up to now. Most babies at a year need about 500 ml (about a pint) of mother's milk a day.  He can easily get that breastfeeding in the evening, during the night and first thing in the morning. During the day he could have a cup of water to drink with his meals.  In the three days a week you are with him all day, he can make up any nursing and in-arms time he has missed.

Breastfeeding mothers who are employed, nursing older babies or raising their children alone need quite a bit of support in Western societies because their situations are still a bit unusual.  You are doing all three! Your local La Leche League or other breastfeeding support group may offer special group meetings for mothers in one or more of the situations you are in.  And for sheer delight and inspiration, you will want to read La Leche League's book for working mothers: Hirkani's Daughters"; Women Who Scale Modern Mountains to Combine Breastfeeding and Working.