Miriam's casebook - A working pregnancy
Vicky, a junior partner in a firm of accountants, passed her accountancy exams while she was expecting her first child, now six years old. She knows that she can combine work and mothering, having worked since shortly after the birth of her son.
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Vicky's challenge now is to combine pregnancy with her working life, be a mother to a schoolboy, and keep up a good relationship with her partner.
Combining motherhood and work
Vicky decided to continue with a very demanding job while she had her second child. To do this, she had to fit the pieces of her life together like a jigsaw puzzle.
She told her colleagues that she was pregnant right away and arranged to talk to them about her maternity leave. I advised her to eat well so she had all the energy and nutrition she needed to keep working while her pregnancy progressed and her baby developed.
I explained that as no two pregnancies are alike, Vicky could not know how she would feel this time around. I advised her not to commit herself to staying at work beyond the 32nd week, but suggested that perhaps she could make an informal arrangement to do so if she felt well enough when the time came.
Planning maternity leave
When to return after maternity leave is a more complicated decision. Vicky's menstrual cycle may take only three months to get back to normal, but her muscles and various organs would probably need more time. The process takes a year altogether. I explained to Vicky that she would need to make special feeding plans if she went back to work before her baby was six months old. As she didn't want to give her baby formula milk, she'd have to express her breast milk and freeze it and would need to allow time to build up a stock of milk initially, then a further six weeks for her baby to get used to breastfeeding and taking breast milk from a bottle.
I suggested that Vicky could arrange a provisional date for her return to work, and check with her doctor as she neared her return date. When choosing a carer, I suggested that she checked out all the available options well in advance - crèches, daytime nannies, childminders, au pairs - to find a carer who was just right.
Making time
I advised Vicky that she would need to plan to have some time alone with her new baby every day, and her son, Jack, who would also need lots of attention and reassurance at this stage. I explained to Vicky that the best way to give him this was to make sure he has his own special time with her, so that he doesn't feel shut out. She would also need to factor in time alone with her partner, Peter, so that their relationship didn't suffer. Above all, I advised Vicky to ringfence some time to herself - one free hour a week when nobody made any demands upon her. Many mothers feel guilty about taking time out for themselves but it's really important if you're going to be relaxed and happy.
Settling into a routine
We agreed that Vicky would feel less overwhelmed if she had a routine to work to, and that the rest of her family would also feel happier if their days were structured. For example, Vicky could spend time with her baby when she gets back from work. She could encourage Peter and Jack to bring her a cup of tea, make sure she's comfortable, then leave her with her baby while they went off to play and chat together. Her special time with her son could be his bedtime, when she could read him a story and listen to him talk about his day. She and Peter could then have an evening meal together and chat, before the baby's late-evening feed.
Adjusting to changes
I suggested to Vicky that six weeks before she returned to work, she should start weaning her baby off the breast for her daytime feeds, replacing one feed with bottled breast milk. Her baby would also need time to get used to the new carer. In fact, her baby developed close bonds with her carer, who'll be an important person in her life. But this won't affect her relationship with her parents.
When Vicky returned to work, her baby adapted to a new routine. She accepted bottles of expressed milk quite easily as she had been introduced to bottlefeeding before she was five weeks old. Initially she had refused to accept milk from a bottle so Vicky experimented with bottles with different types of teat until she found one her baby liked.
Expressing and storing breast milk
I explained to Vicky that she'd need to keep up a good supply of breast milk by feeding her baby or by expressing it regularly. Leaving milk in the breast discourages further milk production and supplies soon dwindle. Vicky was sure that she would have enough milk for her to be able to express some just after feeds so that she can gradually stockpile milk for future use. When back at work, Vicky found that her breasts became full twice a day, so she made time to express using a breast pump. She expressed her milk in the comfortable ladies' room and stored it in a refrigerator in her office until she went home. She sterilized all containers and kept her milk in the refrigerator no more than 48 hours - it can be stored for up to six months in the freezer.
Coming home to the family
At home, her carer was responsible for defrosting each day's supply of breast milk. This should usually be done in the refrigerator, although if you need to defrost breast milk quickly, you can place the container under running lukewarm tap water. Leftover milk must be thrown away and never kept or refrozen for later use.
Now, when Vicky gets home from work her breasts are full of milk and her baby is ready for a feed. I did warn Vicky that her baby will be quick to figure out that although mummy is away during the day, she is there all night, and may become a wakeful baby, as two of my own sons did. I advised Vicky that she would need to establish a routine that helps her baby sleep through the night so that she, too, could get a decent night's sleep.
Miriam's top tips
Vicky needs to make her own well-being and her baby's the top priority in all her plans. The keys are managing her time well and being sensitive to her own needs. My advice is to:
- make arrangements about when to leave work and when to return, and set up childcare well in advance to smooth the transition
- build a support network with other local working families so you can help each other out.
- make time in a busy schedule to relax and take stock.
Posted 04.05.2011
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