What to know about breastfeeding during residency

By Sarah Handzel, BSN, RN | Fact-checked by Barbara Bekiesz
Published April 6, 2022

Key Takeaways

  • Every lactating resident physician has the right to pump at work in a safe, private space.

  • Many residents don’t feel as though current accommodations and policies are adequate to help them maintain breastfeeding for as long as they need it.

  • Hospital leadership, program directors, attending physicians, and medical residents all have a responsibility to improve the breastfeeding experience at work.

Medical residents know that breastfeeding is best for both mother and child, but many encounter challenges to pumping breast milk upon return to work after parental leave.[] These barriers can be significant, and some residents choose to stop pumping breast milk long before they’d originally planned to.

If you’re in medical residency, you should know your rights involving pumping, as well as common barriers that prevent many women from meeting their breastfeeding goals. As more women enter the medical workforce, organizations, attending physicians, and other residents must take steps to empower and enable female residents to continue pumping.

Know your rights

The Fair Labor Standards Act of 1938 was amended in March 2010 to require employers to provide lactating mothers with sufficient break time to pump, as well as a private, safe location in which to do so while at work.[] Any employer with at least 50 employees is held to this standard. Employers with less than 50 employees must also adhere, unless they can demonstrate that compliance with the Act causes undue hardship on the employer.

Nursing mothers must be accommodated by providing reasonable break time to express breast milk for up to 1 year after a child’s birth.

Employers must also offer a private location other than a bathroom for lactating women to pump. This location must be shielded from view, free from intrusion, and available as often as needed. 

One thing to keep in mind is that employers aren’t required to pay nursing mothers for pumping breaks. You’ll need to review your workplace policies to determine whether you’ll be paid for time spent away from patient care duties.

Lactation barriers

A growing body of research points to common barriers many nursing residents experience after returning to work. In 2020, BMC Pregnancy and Childbirth published a study examining the challenges resident physicians experienced while trying to maintain their breastfeeding efforts during their programs.[] The results showed that, among lactating residents:

  • 73% reported that residency interfered with their ability to lactate.

  • 60% had no place to store expressed breast milk.

  • 48% reported that colleagues, including attendings and program leadership, made them feel guilty for pumping.

  • 40% said fellow residents made them feel guilty about pumping.

  • 21% had access to usable lactation rooms within their hospital.

Overall, 37% of study participants stopped breastfeeding before they wanted to.

Additionally, the study found that 56% of participants experienced mental health issues as a result of their inability to breastfeed during residency.

Another study, published in BMJ Open, echoed these results.[] The scoping review found that many lactating women experienced a lack of adequate and accessible space, lack of colleague support, lack of adequate time to pump, and lack of schedule flexibility. Additionally, the discontinuation of breastfeeding earlier than anticipated was a common theme, as were medical complications like low milk supply and mastitis.

Improving the experience

Hospital administration, program directors, and attending physicians must realize their responsibility to accommodate breastfeeding residents. In doing so, the most common barriers to the continuation of breast feeding can be identified and addressed. The American Academy of Family Physicians outlines several steps beyond the minimum requirements dictated by federal law to improve the breastfeeding experience for medical trainees, including:[]

  • Installing computer workstations and a phone in every lactation room. This helps nursing resident physicians stay on top of work and study responsibilities even while pumping. The presence of a phone that’s connected to the hospital system allows residents to quickly respond to pages or other alerts.

  • Offering lactation support. Professional breastfeeding support from colleagues, including lactation consultants, can improve a facility’s culture of support for lactating residents.

  • Placing hospital-grade pumps in lactation rooms. These powerful pumps help minimize the time necessary to express breast milk. Also, residents don’t have to worry about bringing their own pumping equipment to work.

These are all good solutions to improving the breastfeeding experience, but residents should also be comfortable advocating for themselves. 

The BMC Pregnancy and Childbirth study found that many residents regretted not asking for help and not advocating for their right to breastfeed. Many also suggested that having more female leaders in the medical field could help “normalize breastfeeding” and set a new precedent for all lactating healthcare professionals.

What this means for you

Resident physicians are expected to stay on top of their studies and patient loads even while breastfeeding. Hospitals offer some accommodations for lactating residents, but research shows these are often lacking. Working together with hospital leaders while also advocating for yourself can help improve the breastfeeding experience.

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