Breastfeeding Medicine

Physicians blogging about breastfeeding

Physician Mothers: How do we fare with breastfeeding?

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A recent study published in the Breastfeeding Medicine by Sattari et al looked at breastfeeding intentions of female physicians.  They looked at breastfeeding behavior of these women at 3, 6, and 12 months.  Not surprisingly, of the 50 women surveyed, 100% of these physicians had intentions of long-term breastfeeding.  However, as the results showed, the rates of exclusivity/any breastfeeding declined as the women were followed. Although the sample size was small, it brings to light many of the issues women physicians face when going back to work.

Physicians know the benefits of breastfeeding, and it’s interesting to see that most plan on breastfeeding.  The authors point out that not only does breastfeeding benefit the mother and her baby, but our personal stories can usually help a patient.  In my case, breastfeeding didn’t come easy.  My personal struggles to provide breastmilk for my 3 children have helped me counsel mothers in my pediatric practice.  But ironically, even though I work in a field that should obviously support breastfeeding, this wasn’t my experience.  I struggled with finding the time and space to express milk—and yes, I did pump in a bathroom stall!! Ironically, it was after my 3rd child, when I was working in a Pediatric emergency room, that I was given the most support: nurses told me in the middle of my shift to go pump, with my director even offered me a hospital-grade pump!!

This study highlights that specialty and stage of career can and do affect breastfeeding longevity.  Attendings are generally in the best position to alter their schedule to accommodate pumping breaks, as opposed to residents.  During residency and fellowship, I had many friends who chose to breastfeed only for the 6 weeks of their maternity leave, or found, after returning to work, that the long hours and stress of call nights severely diminished their supply.  A primary care specialty is more likely to be favourable, compared with a surgical specialty where women struggle to find time to pump during the day.  The authors point out that the logistics of timing of surgeries and proximity of lactation rooms make it difficult for women in surgical subspecialties to express milk.  I’ve seen this among my friends as well—regardless of stage of career.  One friend mentioned that due to the timing of the cases and fear of missing an interesting case, she would have to choose between eating or pumping since there wasn’t enough time to do both.

Although the study didn’t address this, I suspect that many women in surgical specialties still have to deal with the fact that they may still be in a male-dominated specialty, and bringing up the topic of time and space for expressing breastmilk would not be well-received.

As the RRC has instituted a decline in resident work hours, this may work favorably for women doctors who choose to continue to breastfeed.  However, every woman, every specialty, and every institution is different.  What works for one may not work for another.  But I have to ask: with the passage of the new health reform bill and the increasing popularity of the Business Case for Breastfeeding, can these programs catalyze change within our medical specialties?

There is a light on the horizon. As a breastfeeding community, our efforts to educate and advocate have put the terms breastfeeding, expressing breastmilk, and workplace in the forefront.  10, 5, or even 3 years ago, we wouldn’t even be having this discussion.  My hope is that with this increasing attention, women in the medical field will feel that they have more options to continue nursing after returning to work—regardless of specialty, work hours, or stage of career.

I ask my medical colleagues: what were your experiences, and what changes can make to support our own?

Natasha K. Sriraman is a general pediatrician and a professor of Pediatrics at Children’s Hospital of The King’s Daughters/Eastern Virginia Medical School in Norfolk, VA.

Posts on this blog reflect the opinions of individual ABM members, not the organization as a whole.

Written by NKSriraman

January 4, 2011 at 11:29 am

8 Responses

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  1. […] This post was mentioned on Twitter by Amy West, CLC. Amy West, CLC said: RT @BFMedicine: ABM member Natasha Sriraman blogs on obstacles to #breastfeeding for physician moms. http://fb.me/RBmbhstR […]

  2. So here is my story: I was the first neonatal fellow to be pregnant in my program (resident or fellow!) 23 years ago. They did not know what to do with me! I had to “make-up” my calls (every 3rd or 4th night in-house, doing day before and after) either before or after my baby was born. I chose before–it was hell to be pregnant and working that much–and I did not get them all done, because I had some 1st trimester bleeding and was out on bed rest that I had to make up too. Two of my colleagues kindly and unselfishly gave me calls so I did not have to make up any after my son was born.

    But I was away from him for 36 or more hours at a time, every 3rd to 4th night, after a very short 6 weeks leave. I was determined that he would NOT have formula if it was the last thing I did. And anyone who knows me knows I can be very stubborn. And I was blessed with a great milk supply, even with the pump. I pumped whenever I could, whether I needed to or not. I did it anywhere I had a table and a phone, so I could answer pages. I ate, charted, even closed my eyes for a brief “nap”. I think I was a woman obsessed. Making milk, and getting home to my baby, were above all else. And I did it. I did not know about exclusivity in those days–but he was exclusive for almost 6 months; and was breastfed for 2 years. I know I was lucky, and it was not always easy; I dripped down my scrubs often; I made rounds ready to explode; I pumped when I had just pumped not that long ago because I had the opportunity and I didn’t know when the next time would come. I was at Children’s Hospital Medical Center in Washington, DC in a combination storage room/classroom/break room/my pumping room without a lock on the door one day when our Chief opened the door to reveal a hallway full of United States Senators who got quite an eyeful one day!!! But I always felt very lucky that through sheer stubbornness I think, I made it work, when there were so many obstacles in my way. I can certainly see why so many in our field give up, and it saddens and makes me angry that those in the field of medicine, especially in Pediatrics, Ob/Gyn and Family Practice, who should know better through what we preach to our patients, we don’t Practice what we Preach with our trainees!!! We need to get our own house in order, don’t you think?? Kathie Marinelli MD, IBCLC, FABM, FAAP

    kmarinellimd

    January 4, 2011 at 12:36 pm

  3. I had my son my first year in practice. Full time, full range family medicine in a small town is almost more work than residency, but it does have a little more flexibility. I had a hospital grade pump and a private office. I was able to feed my son at lunchtime most days. His dad was great about bringing him to me for night time feeds if I was stuck at the hospital. I had great support in the newborn period. But when his weight gain began to falter, his doctor (my partner) suggested formula. I reasoned that I wasn’t feeding him all that much in the daytime and I was trying to get him to “sleep through the night” so he wasn’t eating much at night–when was the kid supposed to eat? So we adopted a family bed and figured out how to mostly sleep and feed more at night and everything went much better from then out. We ended up exclusively breastfeeding til he grabbed a pancake off my plate at 5.5 months, declaring himself ready for solids, and continued breastfeeding well after his first birthday. (Well, past his fourth birthday, but that’s another story.) I had most of the usual challenges along the way, and being a mother has made me a much better doctor. Now I teach residents and work very hard to help those with babies figure out how to make breastfeeding work in their challenging lives. I think it is critical that women physician mothers–and male physician fathers–get to experience positive breastfeeding outcomes in order to be better advocates with patients.

    Anne Montgomery

    January 4, 2011 at 1:33 pm

  4. At the time I delivered my twins I was working for a private practice in a small town. My partners were mainly men whose wives stayed at home and the NP’s in our office were either single or newly married. I just assumed that everyone would support my choice to breastfeed as it is a pediatric practice. Wrong! They appeared to support me on the surface, but I was “booby trapped” at every turn.

    First, they forced me to come back at 8 weeks even though I did not feel like I was ready, because they were short staffed and feeling the brunt of H1N1. Then, they assumed that I could use the same pumping schedule as a previous partner used. She was nursing ONE baby and would go home at lunch, so she could manage pumping once in the AM and once in the afternoon. When I started they only blocked out 10 minutes of my schedule and then wanted me to use an unoccupied patient room to pump…it took me half of that time just to set up. When I complained that it wasn’t working they blocked out 20 min twice a day and told me that if I wanted to leave my pump set up so that I could get done quicker they would give me a box to keep it in and put it in the staff bathroom! Needless to say, I could never pump enough to feed them while I was gone, so I had to supplement with formula while I was at work. It killed me to do that, but I had no choice. I continued to nurse at night and on weekends, surprisingly keeping enough supply to satisfy them while I was home.

    I am proud to say that A)I no longer work for this practice and B)I am still nursing at 18 months. My daughter self-weaned at 16 months but my little man is going strong! If I get to do it all over again, I hope for a much different story. I work at a hospital now, with its own pumping room just for employees, and my colleagues are much more supportive.

    I definitely think it is a tragedy that physicians run into these obstacles, because how can we expect our patients to be successful when we can’t make it happen ourselves.

    Shana

    January 7, 2011 at 2:38 am

  5. “THERE IS NOTHING MORE IMPORTANT THAN YOUR CHILD. NO PATIENT. NO SURGERY. NOTHING. EVERYTHING CAN WAIT UNTIL YOU FINISH PUMPING.” This was the advice a dear friend (and pediatrician) offered me as I prepared to start my chief year of an OB/GYN residency after only 6 weeks home with my daughter. Breastfeeding didn’t come easy for either of us, but once we finally got it (about 12 weeks later), I wasn’t giving it up for anything. I did anything and everything to continue breastfeeding. I only ate when pumping and always had a phone by my side to answer pages (the sound of my pump always drawing curious remarks). I even scrubbed out of cases (good cases) when pumping time came around. It sounds so easy, but that was the toughest (and most joyous) year of my life. I feel so accomplished after reading how so many physicians do not accomplish breastfeeding longevity because of career conflicts! Jillian is still happily breastfeeding at 19 months!

    Jessica Maute

    January 14, 2011 at 12:10 pm

  6. Back at work and barely have time to eat much less pump – lucky to pump once a day, and this my milk supply has diminished significantly

    Stephanie

    July 10, 2012 at 10:50 pm

  7. I am a family med resident in Quebec. I had a year’s paid mat leave so this was never an issue. Mat leave is the problem, not pumping time.

    Cat

    September 27, 2013 at 12:50 pm


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