Tuesday, September 15, 2015

No-BS Book Reviews: "Work. Pump. Repeat" by Jessica Shortall

There are a lot of breastfeeding books out there, and quite a few that I wouldn't recommend to anyone who has to work outside the home in their baby's first year. So it's refreshing to come across a nursing-while-working book which I feel I could actually give to a new mother without worrying that I am going to send her off into a tailspin of anxiety and depression. The book is "Work. Pump. Repeat" by Jessica Shortall, and I got an advance preview of it shortly before its recent release.

The most striking thing about the book is its briskly efficient use of floor-space. As the author tells us, she is not going to tell us about the football hold or lactation cookies, because there are about 2,500 breastfeeding books that do that already. Nor does she waste time on giving us reasons to breastfeed--if we've bought the book, we've probably made our decision by now. 

As a result, almost the entire book is freed up for the most fantastically detailed, practical advice--real stuff, hands-on, mum-tested. The sort of stuff you hear on your favorite forums and Facebook groups, yet somehow never get round to actually copying and pasting into a single place so that you will have all the tips when you need them; it's all here, digested, sorted and put into readable form. Are you looking for advice on how to speed things up if your company has assigned a pumping room in another building? It's here. Practical hints on the best type of clothing to disguise milk leaks? Look no further. What to do if you have no alternative other than to pump in a toilet cubicle? Sorry you had to look for it, but there's detailed advice about that too (did you know that keeping some Post-it notes in your handbag can come in handy for this situation? If you are wondering why, read the book). 

Pump choice, pump usage, bottles, freezers and getting your baby ready for taking breastmilk at daycare are discussed, followed by discussion on practical clothing choices, your rights at work, and how to handle your boss and coworkers. All sections are full of concrete, non-judgmental advice that has a "been there, done that" feel to it. The workplace section is really, really pragmatic. Shortall's research for the book included talking to large numbers of HR /management people, trying to work out what are the best tactics for the average Jane who does want to pump at work but cannot afford to antagonize her boss and lose her job/damage her career prospects with a "These are my rights!" attitude. And the book also gives practical tips on "guerrilla pumping"--how to get by at work as best you can if no proper accommodation is made for your needs. The book puts a lot of emphasis on the everyday realities of breastfeeding, with the workplace plan-of-action broken down in detail to include things like how and how often to wash pump parts, dealing with special and unusual pumping situations, flying with breastmilk, and how to approach HR to suggest improvements for pumping facilities. 

Things I would have liked to have seen? I would have preferred slightly more specific info on the freezer storage times/nutritional value question, including differentiation between chest freezers versus regular freezers. I also think that the discussion on lipase/funky-tasting frozen milk would have been better placed closer to the beginning rather than in the troubleshooting section at the end; given the number of women who end up wasting hours and hours producing freezers full of undrinkable milk, every woman who is going to store serious amounts of the stuff should consider testing for lipase before she gets going. One final point is that I would have attached a brief health warning before advising mothers to read books like The Womanly Art of Breastfeeding and The Nursing Mother's Companion. Not that they aren't potentially useful resources too, but a working mother would be well advised to take some of their advice and philosophies with a pinch of salt, especially since some of it (like advising mothers to leave bottle introduction really late) could potentially sabotage one's ability to return to work and stay sane. Lactation consultants as a group perhaps need a health warning as well, for similar reasons.

Sometimes the book made me feel sad. Because when you're reading a section which gives hints about how to get your pump parts clean at work without anyone seeing them, or how to multitask while pumping to deflect criticism from coworkers about your constant "breaks," part of you thinks "Oh, that's a clever idea," and the other part of you thinks "This is so depressing. Because you have all these women working full time with tiny babies, driving themselves nuts trying to pump and store their babies food all day long, waking up all night long, and then having to hide their pump parts from coworkers because God forbid anyone should suffer the disgusting situation of glimpsing a clean breast pump." And it's just all so sad. But given that this is the crappy reality that US mothers face, I am glad that at least writers like Shortall are doing their bit to try and make things a bit easier for mums.

The other thing that makes the book a standout (other than the level of detail) is the emotional care that the author shows towards her fellow WOH breastfeeders. When she says that "this is a judgment-free zone" she really is not kidding. It is rare and refreshing to see a breastfeeding book that talks about formula choice, preparation and supplementation simply as another option, rather than as some kind of existential failure on a mother's behalf. Shortall also describes her own personal journey from exclusive-breastfeeding obsession to a more pragmatic approach with her second child, and it's clear that is part of the reason why she urges mothers to safeguard their mental health--advice that is not confined to an occasional vague disclaimer about "not judging people," but rather is something that is built into the very structure of the book, influencing all the advice it gives.

In short? Without a doubt, the best and most practical book for WOH nursing mothers that I've encountered, and an excellent buy or gift.

Here is an excerpt from Chapter 3 of the book. Enjoy.

Pumping School

Welcome to School

Pumping makes many women feel like farm animals. For me, it is everything actual nursing is not: sanitized, cold (sometimes literally, if you’ve just washed the parts or tend to keep them in the fridge at work in between sessions), and industrial. It was also totally and completely foreign to me, up until the first time I tried doing it, which is where Pumping School comes in.

Unless they make you pump in the hospital (which can happen), you might find yourself at home, with a baby and a very porn-star-esque pair of boobs, wondering who the hell is going to show you how to use this thing.

I needed someone who could see me with my shirt off to show me how to do it. So my best friend took me to Pumping School.

How to Get Taught

Between weeks three and six of your baby’s life, invite to your home a mother with recent experience with pumping breastmilk. This should be a woman with whom you are comfortable seeing both of your newly gigantic boobs. 

Tell her that she is coming over to teach you how to use a breast pump. You should have your pump and its basic parts, breastmilk storage bags, and a Sharpie or other permanent marker. Time this date so your friend comes by just before the first morning feeding (or during, if she has a key or you have someone else to open the front door for her while you have a baby attached to you). If she has a toddler, suggest that she leave this lovely small person at home. 

You’re going to feed your baby as normal, then pump immediately after the feeding. I recognize how silly and arbitrary a term like “first morning feeding” is. Just pretend that any feeding at or after 6:00 A.M. is the first one of the day, even if it isn’t and it makes you want to throw this book against the wall.

The reason you’d shoot for the first morning feeding for pumping is that your body is making more milk at this time of day. Also, it can help trick your body into making a bit more milk throughout the day. If for some reason you just can’t do this time of day, it is not the end of the world. 

Once you’ve nursed, your friend will set you up with the pump—placing the parts onto your boobs if need be—and have you pump for the first time. She will show you how most pumps have an initial “letdown” setting, which pumps quickly and with less suction, to simulate the way your baby sucks when she is first on your breast. Your friend will show you how it then switches over to the general setting, resulting in slower and deeper suction cycles, again to simulate what your baby does once the milk starts flowing. 

Break for Questions 

Here’s what you might worry about in this process:
1. If I pump after I feed the baby, will I have enough milk for the next feeding? Yes, you’ll be fine. Your breasts are always making milk and you don’t need to “fill up.” In fact, you will probably produce more milk that day because of the increased demand.
2. Will there be any milk to pump since my baby just finished eating? Maybe. Maybe not. This first time around is just for practice, so don’t sweat it if all you see is a few drops.
3. Am I really going to do this several times a day when I go back to work? Um, yes. That’s why you bought this book, honey. If you want to breastfeed after you’re back at work, you are probably going to pump a lot at work. It’s not fun, but it is doable. 
4. Who is going to hold the baby while I do Pumping School? Options: your Pumping School teacher, your spouse, a baby swing or chair, or the floor.

Back to School

During the first fifteen minutes or so (which aren’t going to feel awesome), you might produce a couple of drops, or you might produce 4 ounces and feel awesome. There is no definition of success, other than learning how to do it so it stops seeming so foreign and weird. (Note: It will never completely stop seeming foreign and weird.)

You are going to see, for example, that your nipples are stretching to a greater length than you thought possible (a friend described seeing his wife pumping for the first time as “two thumbs in a garden hose”). 

You are going to wonder what will happen to your sex life if/when (it’s a “when,” trust me) your partner sees this process. It will be awkward, but you’ll both survive it.

You might be surprised to see what your breastmilk looks like. It can be thin and watery or thick and creamy. It can be white, yellowish, bluish, or greenish. In fact, it will be all of the above (which is normal) at different times of the day and over time.

Congratulations. You’ve just joined the most exhausted, most multitasking, most ass-kicking club of women in the world.