Despite being taught to promote breastfeeding in their patients, at least half of all medical residents struggle to achieve their own breastfeeding goals.
Some hospitals still fail to meet legal requirements for providing lactation rooms and protected time for nursing mothers.
Medical institutions should provide flexible working hours, adequate time for milk expression, and private lactation facilities to better support lactating residents.
Returning to work as a resident after an absence can be daunting for anyone—but even more so for new moms who must balance patient care with their newborn’s needs.
This contrasts with approximately 60% of the general US population who achieve this goal. After 6 months, the success rate is even lower, with only 30% of residents continuing breastfeeding at 1 year.
Benefits of breastfeeding
Not all women desire to breastfeed, and not all women who intend to breastfeed may be able to do so successfully. But for those who have the option, breastfeeding offers a wealth of health benefits for both mother and child, per the American Academy of Pediatrics.
It strengthens the baby's immune system and promotes long-term health. Breastfed infants also have lower rates of respiratory and gastrointestinal infections, atopic dermatitis, obesity, and even sudden infant death syndrome.
For mothers, breastfeeding can reduce the risk of developing diabetes mellitus, hypertension, breast cancer, and ovarian cancer.
Challenges of being a lactating resident
Medical trainees are taught to promote and support breastfeeding among their patients, yet they struggle to achieve their own breastfeeding goals. The University of Michigan's Department of Surgery Residency Program has identified critical challenges faced by lactating surgical residents, including:
The inability to schedule lactation breaks in advance due to unpredictable clinical obligations and working hours
Juggling duties with the needs of their newborn results in sporadic or inadequate pumping, which increases the risk of mastitis, clogged ducts, and breast abscesses
Difficulties in finding a private place to express milk
A lack of perceived support from the institution and colleagues
An obligation to notify the program director and all residents in advance if they require time to express milk at work
Emotional stress brought on by extended periods of separation from their young child, affecting the health and wellness of lactating residents
As the writers in the BMJ Open article discussed, the Patient Protection and Affordable Care Act (PPACA)—enacted in the US in 2010—mandates employers to offer institutional assistance and reasonable break times for lactating mothers until the child reaches the age of 1 year. Hospital administration must provide nursing physicians with a private and secure location, separate from the lavatory, where they can express milk without being bothered by employees or the general public.
The recently passed PUMP for Nursing Mothers Act extends these requirements to even those doctors who were excluded from the PPACA due to unintended legal loopholes.
Despite the legal requirements, in 2020 the BMJ Open investigators found that some hospitals or clinics still failed to comply with these obligations.
Building a supportive workplace
In a bid to support new mothers with the nuances of breastfeeding, the American Academy of Family Physicians set some of the following guidelines:
Minimum requirements for a lactation room
One lactation area per 50 to 100 female employees aged 18 to 45 years.
Lactation rooms should provide privacy, comfort, and sanitation and have a locker or refrigerator to store milk and pumps.
Additional considerations include hospital-grade breast pumps, a computer, a phone connected to the hospital system, and professional lactation support.
Provision of protected time
Breastfeeding doctors have the right to 'protected time' at work, allowing them 20 to 30 minutes every 2 to 3 hours for milk expression.
Trainees and supervisors must work together to plan lactation schedules and ensure that patient care is covered in the trainee's absence.
Tips for breastfeeding while working
To stay on top of your game as a lactating resident going back to work, here are some tips gathered from fellow physicians.
First and foremost, acquaint yourself with the lactation rooms in your workplace. The Accreditation Council for Graduate Medical Education mandates that residents have specified lactation facilities.
Join a support group for nursing mothers to get advice on safe medicines, milk storage, and balancing work and breastfeeding. Consider seeking help from a lactation consultant or colleagues who have experience with breastfeeding while working.
Purchase pump accessories for both standard and mobile pumps. Get a waterproof bag to store used pumps at work. Make sure to pump after each session, regardless of the quantity of milk expressed, to build a reserve you can freeze and rely on when you return to work.
Establish good communication with your program director and colleagues regarding your needs. There are also institutional provisions for substitutes to cover your responsibilities while you take time for milk expression.
Don't hesitate to speak up for yourself and request a break if you need to pump. Your program director is also obligated to provide conflict resolution whenever you face a problem with expressing milk due to clinical commitments.
What this means for you
Becoming a mother is a life-changing experience, regardless of your profession. Familiarize yourself with the lactation rooms at work and seek help from lactation consultants or experienced colleagues. Establish good communication with your program director and colleagues, and don't hesitate to request a break. Remember that your medical institution is legally required to support your breastfeeding journey.