The breastfeeding biochemist parent: planning, pumping and perfectionism Open Access

The National Health Service (NHS), the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) recommend exclusively breastfeeding (i.e. giving your baby no other food or drink) for around the first 6 months (Figure 1). “From the age of 6 months, children should begin eating safe and adequate complementary foods while continuing to breastfeed for up to 2 years and beyond”. The second part often comes as a surprise. Reactions to me feeding my 2 year old range from an embarrassed “um… good for you” to an impertinently personal “you need to wean him off”. As a scientist, I like to take an evidence-based approach to decision-making in all aspects of my life. So, here’s the evidence.

The maternal antibodies in breastmilk are protective. Babies who are breastfed are, therefore, significantly less likely to suffer from infections of the ear, urinary tract, the respiratory system and gastroenteritis. These benefits are particularly important for vulnerable children such as premature babies and those with chronic conditions. Breastfeeding is also associated with a reduced risk of eczema, asthma, breathing difficulties and diabetes.

Benefits for mum include the non-trivial, reduced risks of breast cancer, some forms of ovarian cancer and osteoporosis. Another less-obvious health benefit includes the fact that breastfeeding typically burns 500 calories a day; this can help contribute to weight loss or limit weight gain after pregnancy, thereby combating obesity, which is itself a risk factor for many conditions. There are also significant benefits for mental health at a vulnerable time in people’s lives.

The longer one breastfeeds, the greater these benefits. Extended breastfeeding is particularly important for babies who do not tolerate formula or cows’ milk and for those whose parents do not wish them to have products of animal origin (formula is generally not vegetarian, but bringing up vegan/vegetarian children is another article). For those who cannot breastfeed for health reasons/medication, the Human Milk Foundation aims to support breastfeeding, making screened donor breastmilk available to all parents and babies who need it. There may be schemes local to you too. Healthier parents and their children benefits employers too – happier, healthier employees and their children leads to better productivity, less time off work and improved retention.

For most, the majority of their breastfeeding will happen whilst on maternity leave. Many a conversation is had around the best time in your career to have children, strategically. Whilst I understand the motivations behind such conversations, even the best laid plans come awry. Speaking as someone with some difficulties conceiving, including two miscarriages (another neglected conversation topic in science), my great plan of having both my children during my well-paid MRC postdoc with excellent maternity benefits turned into having one just as my contract with the MRC was ending and the second during a personal fellowship where support was initially less clear-cut.

It is an informally acknowledged reality that academics frequently carry on doing their job whilst on leave. The degree to which it happens and how it happens will depend on career stage, circumstances and personal choice. Parental leave can end up being a very productive time if you choose to use it that way. For me, the first few months of parenthood were the easiest. The baby slept a lot and I could get on with reading papers, writing grant applications, teaching prep and so on. In fact, I won my first big co-investigator grant having written my sections whilst on maternity leave. Having a physically smaller and more docile infant also makes it possible to work on a laptop whilst feeding. None of these is meant to imply that we did not also attend a lot of mother and baby classes.

Unless it was really inappropriate, I also brought my baby to meetings and events – convenient for feeding and great for highlighting that scientists frequently have children as part of their broader social responsibilities. Events included careers sessions, conferences (some, e.g. Microbiology Society, have free creches), giving access talks in schools, meetings with collaborators, even to course reviews and graduation ceremonies (Figure 2).

However, once the naps dropped and the small person needed more entertaining, all of the above was much more difficult and then, before you know it, you are back at work.

With my first, I took 7 months’ leave as it conveniently took me to the start of a new academic year. The coincidence of the start of the academic year with peak infection season is something to bear in mind. If you’re in academia, this term is already stressful with new research and teaching students to get to know, undergraduate admissions and so on. Having to abandon ship weekly to schlep your infant to the doctor with his umpteenth ailment (or worse still with something that restricts him/her from childcare) is not very convenient. All the more reason to breastfeed, to limit these infections.

One great local arrangement at the University of Cambridge is the Returning Carers Scheme. This “provides funds to support career and professional development following a career break or a period of leave for caring responsibilities”. The scheme is very broad, funding everything from teaching buyouts to grant-writing support and conference attendance. The catch is that only university staff are eligible, so those with personal fellowships, such as me, lose out.

Another local mechanism of support is a Returning to Work session. Whilst some of the advice was largely inapplicable to the practicalities of academia, for example, “just block pumping sessions out in your shared calendar”, one piece of advice really stuck: “choose your deal-breakers and stick to them”. The reality is that if you are combining work with parenting, you will never be perfect at either, no matter how hard you try (or perceive others to be). Choosing your “deal-breakers”, be it always being home for bedtime routine or not working weekends, makes you consider what is important for your family and where to draw the line. My deal-breaker was giving my children breast milk for the recommended 2 years and that inevitably meant combining breastfeeding with work (Figure 3).

The fact that academics typically take short maternity leaves means many find themselves needing to juggle breastfeeding with their professional commitments. There are various ways to do this. If your childcare is close by, you may be able to pop over for feeds during the day. I considered this, but found that it would be very disruptive for both me and my children. I, therefore, went down the route of expressing (“pumping”) milk, the basic premise of which should be familiar from the dairy industry.

Control of milk production is complex, the subject of study dating back to at least 2300 BC. The physiology of milk production encompasses development of the mammary gland to adulthood, changes during pregnancy and post-partum, with the accompanying metabolic and behavioural adaptations. Milk is produced and stored in the alveoli and dilated ducts deep within the breast tissue. Stimulated by infant suckling, the neuroendocrine reflex ‘let-down’ occurs. Nerve impulses travel from the nipple to neurons in the hypothalamus and stimulate synthesis and release of the peptide hormone oxytocin. The propulsive action of the let-down reflex forces the milk from deep within the breast towards the nipple and baby, aided by infant suction. Expressing aims to mimic this process for milk collection and storage for subsequent feeds.

Many will only anticipate expressing when they return to work. I would suggest, however, that it helps to pump from the outset (and some mothers find they have to). Starting early means you can work out all the issues and find the right pump for you (as well as building up a frozen stash) before it becomes crucial. Whilst on leave, you may choose to be away from you child for ‘Keeping-In-Touch’ days, conferences and/or meetings. You might also be ill or need a well-deserved night out. It is also difficult to predict how much your child will drink when away from you, so having plenty of backup is good.

It is possible to hand express, but this can be less efficient and hard work on the hands. So, herein comes the technology. There are three main types of pump:

1. Manual – Handpumps are cheap, portable and do not require power, but are a massive no-no for anyone with any repetitive strain injury (RSI; see below). There are also suction-only devices designed to be used to collect milk from one breast whilst feeding from the other (time efficient, but difficult if your baby is wriggly). Milk collection shells/milk savers can collect the leaking milk, so it is not wasted.

2. Domestic electric – These tend to be more powerful, but require either a plug socket or batteries. Different brands are available and it is worth doing your research. Sophisticated models mimic the different phases of suction during a feed. Double versions are available and price will reflect this and the quality of the pump. Adapted bras can hold the collection components in place, so that you can achieve hands-free pumping. A combination of all of these things with batteries can bring hands-free, free-range pumping (although it’s a look you would only sport in private).

3. Hospital grade – These are quite a bit more powerful, and thus bigger and not portable. They are also very expensive, but you can hire them on a monthly basis. I found this useful in the early days with both my underweight children when I had to express between feeds to increase the supply and top them up.

4. Wearable – Free-range pumping! It just sits in your bra, is quiet and discrete. This was a gamechanger for me. You just need 30 seconds somewhere private at the beginning and the end of each session to transfer the milk to a fridge.

Workplace regulations require employers to provide suitable facilities where pregnant and breastfeeding mothers can rest. Furthermore, the Health and Safety Executive recommends that it is good practice for employers to provide a private, healthy and safe environment for breastfeeding mothers to express and store milk (not a toilet). In practise, with my first in 2015, I found it very difficult to find places to pump at work. My department refurbishment had been delayed, and so I found an empty office in our temporary building. The risk of interruption makes for a stressful experience, not compatible with efficient let-down. When we moved back, meeting rooms were heavily used and all had transparent entrances. I ended up surreptitiously pumping under a pashmina in our communal office, not ideal. The time out from the lab to express for 30 minutes four times a day (this will vary depending on the person) can be too disruptive depending on your circumstances. However, with some planning, it is possible to combine experiments with pumping whilst catching up on reading/admin/ writing/teaching prep. My advice would be to speak to your HR department before you go on leave to find out about the options and make them aware you intend to pump when you return.

The second time around, with the advent of wearable pumps, expressing anywhere and everywhere became doable. I have pumped whilst doing tissue culture, flow cytometry, teaching, in undergraduate admissions and staff interviews, during conferences, formal dinners, you name it, my pump has come with me. This also gets around another major issue: pumping at conferences. Whereas normally you have to miss all the networking coffee sessions to pump, now I just pump whilst in the sessions.

Breastmilk, unlike formula, is quite stable (see Table 1). Luckily most, if not all, workplaces have a fridge, so storing expressed milk is usually fine. Make sure it is labelled with name and date to prevent loss/confusion. In the summer, you may need to use cool packs to transport it. Most conference venues and hotels will also store your milk if you ask (especially if you do not accept no for an answer!). Bring freezer packs with you to get it home.

As with pregnancy, working as a breastfeeding mother requires risk assessment. The risks could be biological, chemical, radiological, physical and or mental and have implications for you and your infant. Speak to your occupational health department about the risks associated with your work. Something to particularly mention is RSI associated with office work, lab work, feeding and pumping positions, and hefting babies about! Try to incorporate correct posture, breaks and stretches into your day (see Further reading).

All that said, pumping in certain work scenarios is going to be difficult: clinical work, containment spring to mind, but it is worth having a conversation about it. If pumping at work is definitely a no-go, then partial breastfeeding can be a good option. It does not have to be all or nothing. You may want to feed your baby when you pick them up from childcare and at home. This can be a lovely bonding experience after a day away (and a guilt assuager!). As with other aspects of science/life, use local experts. Seek out other mums breastfeeding through social media or at nursery drop-off. They can be a source of practical and moral support; be it a working mum’s messaging group, the “Can I Breastfeed In It?” Facebook group or reading scientists’ Twitter rants about breastfeeding at conferences. There are many sources of information and solidarity.

Finally, whilst this article is chiefly on breastfeeding, I will also mention sleep.

A colleague once likened early parenthood to being hungover all the time – I laughed, but who is laughing now? Sympathize with the forgotten sleep deprived – those with toddlers and older who still do not sleep through and who have accumulated years of interrupted nights’ sleep. I can count the number of >3-hour sleep sessions in the last 2 years on one hand. The resulting operational fog is something to bear in mind when interacting with those who could be sleep deprived. Long-term sleep deprivation leads to difficulties in concentrating and making decisions, anxiety and depression. The risk of accidents and injury at work is also increased – something to bear in mind in the lab context. If you combine sleep deprivation’s negative effects on immunity with living with a young child, parents of young children are likely to be ill a lot of the time, but may not feel they can take time off.

When evidence suggests that the success of your team is directly correlated with how many women are on it, it makes sense to support their recruitment and retention in any industry. I work on a biomedical campus, which includes a large teaching hospital. Both my children attend(ed) nursery onsite. Parents of the children at the nursery (from 4 months to 4 years), therefore, largely work in healthcare or in science. In my two years of bringing my bottles of liquid gold in for my children, I have only shared the nursery fridge with a maximum of one other pumper at any time. With around 60 under-twos in the nursery, I see that as pretty damning evidence of a lack of support for pumping in the workplace. For this piece, I reached out to several institutions on campus about the availability of lactation rooms. Some have first aid rooms suitable for pumping, which is definitely better than nothing. However, breastfeeding mothers report being disappointed that even brand new buildings did not incorporate a parents’ room.

So, what can employers do to support breastfeeding? Acknowledgement and support with clear policies including flexible working opportunities are key. The single most important thing in my mind is to provide a bookable, private, comfortable room where mothers can express milk (ideally the facilities listed in (Figure 4). Pumps can be expensive, prohibitively so, especially on a scientist’s salary. Provision of a pump would be a landmark inclusive move – a step towards the holy grail of breastfeeding support you see in Silicon Valley lactation rooms, for example. Training and financial support for returning carers, such as those described above, also help.

What can co-workers do? Be supportive, encouraging and accepting of mothers who need time and flexibility to breastfeed. It is not a big deal, no one needs to be embarrassed, but it may well be a source of stress. It is part of broader acknowledgement that colleagues/students/anyone might have other things going on, like caring for older parents (not as well defined and supported as parental carers), chronic illness or myriad different curveballs. Be understanding if they appear to be ignoring your email on a Saturday or are not 100% focussed during a meeting. I know I am guilty of this behaviour but am trying to be better.

Breastfeeding

Feeding tracker – for when the health visitor comes around and asks how many times you have changed your baby and how many feeding sessions and for how long, which side and other fun questions

Although a lovely bonding experience with your baby and technically a chance to relax, like many, I multitask. So, here are some apps that can be used to make breastfeeding mum’s life easier and to use this time if you choose to.

Twitter – Love it or hate it, I find it very useful to keep up with science, funding calls, jobs, outreach.

Pocket – I try to keep up with science news and education policy, but find reading articles in my precious child-free time during the day to be a distraction. I use Pocket to save articles and webpages for reading while feeding.

Notes – Breastfeeding can be a great time to let your mind wander. Find a way to record your latest experiment idea or perfect wording for a difficult student conversation. I have a voice recorder which you can then transcribe on various free websites if needed.

Podcast player – great for keeping up to date in your field. Use Bluetooth earphones to stop your child pulling them out.

Audiobooks – great for work-related books or otherwise.

Life admin

There are millions of things that could go here; to find the best support for what you need, see “Using Networks” above. However, my life would grind to a halt without:

Shared calendars – I have calendars for work (personal and team), home, children, children’s school and can see my husband’s work calendar, essential for organizing drop-offs and pickups. Before I say yes to something, I try and make myself block off the time in my diary. If I cannot do it, then I try and say no.

Supermarket delivery apps – combine with shared shopping lists, for example, Microsoft ToDo.

Work and contingency

Despite being a lover of handwriting, I made a pledge to eliminate paper from my life for environmental reasons, because it is heavy, and because it can be in the wrong place!

e-labbook – I use Benchling – much easier to keep up to date on the go, easily categorizable and searchable. Also, automatically backed up and easily shared. Some institutions still mandate a physical lab book, but you can still print and stick.

Ability to work from home at the drop of a hat – VPN, always taking your laptop (and cables) with you, organizing off-site software licenses or dongles – whatever you need. If you need to move a laptop, get a robust but light one to save disasters and backpain, respectively. I would also always do any experimental work you need to first thing in the morning in case you get called to pick up ailing children. I have learnt never to rely on future time as it may not exist.

Backup – We have a NAS box at home which automatically backs up everything on my laptop to the home server using Synchthing. This means I can easily work at home if the children are ill or if plans change at the last minute. It also means I can work at home or in college without my laptop, saving moving it about.

Group messaging, for example, Slack – for quickly keeping in touch with colleagues (if this fits your team’s style)

Academic science brings with it many challenges. Throw into the mix being a woman, a parent/carer and then a breastfeeding mother, and things can get more complicated. In this feature, I have focussed on breastfeeding specifically rather than discussing other issues around retention of women in STEM, such as job security, geographical limitations or ‘the motherload’. Hopefully, I have challenged you to consider how we can support parents in science to breastfeed for the recommended period, including a wish list, with examples of new initiatives, for those in power to consider. I have shared some of the tips and tricks I have picked up during my experiences of breastfeeding two children whilst trying to establish an independent career in science. Hopefully this information will encourage some more bench scientists to give it a go. Happy pumping.

• WHO info and guidance https://www.who.int/health-topics/breastfeeding

• Endocrinology of milk production https://www.ncbi.nlm.nih.gov/pubmed/15876512

• Expressing and storage of milk https://www.nhs.uk/conditions/pregnancy-and-baby/expressing-storing-breast-milk/

• Breastfeeding support and research https://www.laleche.org.uk/

• Returning to work rights https://www.acas.org.uk/your-maternity-leave-pay-and-other-rights/returning-to-work-after-having-a-baby Has lots of information for employers and employees about rights around returning to work.

• Lab RSI avoidance https://blog.universalmedicalinc.com/6-ways-prevent-repetitive-strain-injury-lab/

• returning to teaching after leave https://adept.qmul.ac.uk/resource/teaching-maternity-leave/ and https://www.timeshighereducation.com/blog/returning-academic-work-after-maternity-leave

Harriet Groom (@harrietgroom, www.groomlab.co.uk) is a visiting research fellow in the Department of Medicine and Bye Fellow at Downing College, University of Cambridge. She researches the genetics and molecular biology behind innate immunity to viral infection. She also teaches first year cell biology and is an Editorial Board member of The Biochemist. Email: [email protected]