Mother-baby separation

Do I have to express if I leave my baby?

Mothers who are breastfeeding and need to be away from their babies need a plan. Many mothers express and freeze breast milk to create a supply for when they are away. Once away, it is best to express around the time the baby normally feeds. Mothers can save the milk for use the next time they are apart from their baby. Missing breastfeeds without expressing has major risks. Milk will collect in the breasts which can create painful problems for the mother and over time, reduce the milk supply. The mother’s periods may return early, which can further reduce milk supply. 

A) Describing mother-baby separation

If mothers are breastfeeding, the safest way to ensure their health and the baby’s well-being is to breastfeed when the baby is hungry. However, mothers may choose to or may have to be separated from their babies. Returning to work is a common reason for mother-baby separation. 

Expressing effectively for every breastfeeding session the mother has to miss will allow her to continue breastfeeding the baby and avoid problems.

B) The need to express during mother-baby separation

Milk can build up in the breast if the mother is separated from her baby and she:

  • Skips breastfeeds without expressing.
  • Delays expressing.
  • Expresses ineffectively.

The more milk that collects in the breast, the fuller and more uncomfortable the mother will feel. The breasts may even become engorged, which may make it more difficult for the baby to latch and may cause nipple pain.

When the mother does breastfeed, the baby may not be able to take in enough milk to relieve the breast fullness and pain. The mother may have to express after breastfeeding to be comfortable. Some mothers cannot express effectively, so their breasts continue being overfull for several feeds until the baby can finally remove the excess milk.

When milk is not removed regularly, mothers may also notice nipple and breast problems:

Over time, mothers may notice:

In short, skipping feeds without expressing or expressing effectively has risks for mothers and babies.

Mothers who are skipping breastfeeds in order to wean, must also make sure their breasts are not too full.

C) Planning for mother-baby separation

Mothers who are breastfeeding and need to leave their home may find it easier to take their baby with them than make alternative child-care arrangements. Many places can accommodate babies. Sometimes, however, mothers may have no choice. Before leaving their baby, mothers should consider making a plan. 

1) Make a milk stash

Many mothers create a stash of frozen expressed breast milk for the baby for emergencies or for when they are away. This is good planning. If mothers don’t already have a stash, they will need to express enough milk ahead of time to cover the baby’s needs for when they are away.

When mothers and their babies are separated, it is best to express around the time the baby feeds instead of skipping a feed and not expressing. The milk brought home after the separation can be frozen and used the next time they are separated.

2) How to express when separated

Mothers who choose to express when separated need to decide whether to:

Some insurers will provide funds for breast pumps if prescribed by a health-care provider.

Mothers should know how to:

  • Improve their expressed amounts if they are not expressing effectively.
  • Increase their milk supply if it is reduced by extended separation.

Other considerations for expressing:

  • Is there a clean, private space to express?
  • Where can they wash their hands and their expression tools?
  • Where can they store their milk?
  • When can they express?

3) How to travel

Before travelling, mothers need to decide how to:

  • Transport expression tools, such as pumps and storage containers
  • Safely transport their milk

4) How to feed the baby when the mother is absent

The baby will need feeding when the mothers is away. Decisions must be made around:

  • Which type of milk should be used? 
  • How to give milk to the baby?
  • How much milk to give?
  • Who will feed and care for the baby?
  • Are the baby’s caregivers supportive of breastfeeding and breast milk feeding (Dieterich 2019; Gonzalez-Nahm 2017; Schafer 2020).

5) Do a trial run

Even the best plans can go sideways. For example, some may refuse their mothers’ expressed milk if it has acquired an odour. They may not like the taste or smell of infant formula. Other babies may be unable to use bottles.

Mothers should consider testing their plan with a trial run of separation. This is a situation in which the mother can quickly return to the baby if there is a problem during the separation.

D) Mother-baby separation of several hours

If mothers are only going to be away for an hour or two, they may be able to get out and back between feeds.

If the baby feeds before the mother gets back, it is best if they express around the time that the baby feeds.

E) Mother-baby separation of a day

If mothers are going to be away for a whole day, they will probably need to express for several feeds.

Some mothers:

  • Do not express well.
  • Are not in situations where they can express.
  • Choose not to express when separated.

Mothers who do not express for missed breastfeeds will find their breasts becoming fuller as the day goes on and with each missed feed. If this is your situation, see if you can minimize the number of breastfeedings you miss. Here are some possible approaches:

  • Can someone bring the baby to you?
  • Can you get home during the day to breastfeed?
  • Can you split an away day into halves?

Returning to work may require additional planning.  

F) Mother-baby separation of several days

1) Taking the baby along

Mothers who need to leave for several days can consider bringing the baby and an other caregiver, such as a partner, grandparent, other family member, or friend. The caregiver can call the mother to return to breastfeed when the baby is hungry or meet the mother in a convenient location. This way mothers:

  • Will know their baby is well cared for.
  • Don’t have to spend time expressing.
  • Can work or enjoy their time away from work, depending on the nature of the trip.
  • Avoid many of the breastfeeding complications that come with being separated from their baby and not expressing effectively.

2) Leaving the baby behind

The alternative is leaving the baby at home. If mothers go away for a few days without their baby, they are going to have to rely on expressing.

a) Risks of expressing over several days

Mothers will need to be very effective at removing milk from the breast to avoid becoming overfull and developing breast problems. They won’t have much fun or get much work done if they are in pain and dealing with the various problems that can result from overfull breasts. Mothers may need medical attention if they develop mastitis or an abscess.

b) Risks of not breastfeeding over several days

A baby may not wish to resume breastfeeding after several days of replacement feeds or may not grow well, because the mother’s milk supply is reduced after the trip.

c) The difficulties of transporting expressed milk

When transporting expressed breast milk, mothers need to consider:

  • How long they are travelling.
  • How they are travelling.
  • How best to keep expressed milk safe during this time.
  • How to deal with sudden, unexpected changes travel plans. 
  • Bringing any expressing supplies with them instead of trying to locate them in an unfamiliar city and possibly in a limited amount of time.

If mothers are driving, expressed milk can be safely transported in a cooler with ice for 24 hours. 

Flying can create additional headaches because of unexpected events and various arbitrary regulations that can vary between airports, airline companies, and countries. If mothers plan on flying with expressed breast milk, they can:

  • Review their options before they leave.
  • Consider taking copies of the regulations regarding the transport of expressed breast milk with them.

References

Dieterich R, Caplan E, Yang J, et al. Integrative Review of Breastfeeding Support and Related Practices in Child Care Centers. J Obstet Gynecol Neonatal Nurs. 2019;S0884-2175(19)30471-X
 
Gonzalez-Nahm S, Grossman ER, Frost N, et al. Early feeding in child care in the United States: Are state regulations supporting breastfeeding? Prev Med. 2017 Sep 28;105:232-236

Schafer EJ, Livingston TA, Roig-Romero RM, et al. "Breast Is Best, But…" According to Childcare Administrators, Not Best for the Childcare Environment. Breastfeed Med. 2020 Oct 20