Towards Improved Support for Medical Trainees Who Are Breastfeeding

Dr. Helen Johnson

Ironically, physicians have some of the lowest rates of breastfeeding in the United States. Despite acute awareness of the medical risks of not breastfeeding and deep commitment to educating their patients about the importance of breastfeeding, many physician mothers face significant challenges in their own breastfeeding efforts. Medical trainees – including medical students, resident physicians, and fellows – are among the most vulnerable. This month’s IABLE podcast focuses on how to improve support of medical trainees who are breastfeeding.

Dr. Anne Eglash recording the IABLE podcast.

Medical trainees have jam-packed schedules with little to no control over their time. It can be a small feat to find time to scarf down a snack between surgeries or surreptitiously slip away from hospital rounds to run to the bathroom. In a culture in which self-sacrifice for the greater good of one’s patients is the norm, devoting 20-30 minutes every few hours to express breastmilk can feel like an indulgence. In addition, trainees may fear being perceived as less dedicated than their peers to their education or to patient care should they attend to personal needs at work. Even in a workplace environment that strongly supports breastfeeding – such as the obstetrics/gynecology department – lack of accessible, sanitary, and private spaces can limit a trainee’s ability to breastfeed at work.

In the past several months, several steps have been taken to improve support for medical trainees who are breastfeeding. In June, the American Academy of Family Physicians (AAFP) published a statement (https://www.aafp.org/about/policies/all/breastfeeding-accommodations-trainees.html) stressing the need to better support these women through policies that address protected time, adequate facilities, and a supportive workplace environment. On July 1, new Accreditation Council for Graduate Medical Education (ACGME) regulations went into effect: residency and fellowship programs are now required to provide clean, private lactation facilities for trainees that are in close proximity to patient care and include refrigeration capabilities.

Dr. Rebecca Snyder cartoon from her days as a surgical resident.

The ACGME notes: “While space is important, the time required for lactation is also critical for the wellbeing of the resident and the resident’s family.” Last month, a departmental lactation policy implemented by the surgery departments at the University of Michigan and the University of Wisconsin was published. This policy has been circulated on social media and adapted by dozens of other departments across the nation.

Most recently, my colleagues and I issued a “call to action”, urging the creation of a universal policy to better support resident physicians and fellows who are breastfeeding. We admire the grassroots efforts to create departmental policies and respect the significance of the new ACGME regulations. However, we feel that there is an urgent need to do more to ensure that all medical trainees have the support they need to breastfeed their children. In our publication, we underscore the importance of cultivating a supportive workplace culture, promoting access to appropriate lactation spaces, and ensuring adequate time for breastfeeding, and suggest specific action steps that program directors and institutional leadership can take to achieve these goals. Our piece was highlighted by Duke Forge and is discussed in detail in this month’s IABLE podcast.

Dr. Helen Johnson and her child visiting her at work as a surgical resident.

The podcast features not only the three authors of the “call to action” but also Laurie B. Jones, the founder of Doctor Mothers Interested in Lactation Knowledge. This online peer-to-peer breastfeeding support group for physician mothers has been instrumental in helping thousands of women – including trainees – meet their breastfeeding goals. Dr. MILK members encourage each other and share their wisdom for balancing breastfeeding and a medical career. Let’s take this to the next level by joining forces with breastfeeding medicine physicians and national organizations – together, let’s advocate for a universal lactation policy for medical trainees. ABM has already confirmed their support of the AAFP’s statement. Now it is time to amplify each other’s voices and effect meaningful change.

Dr. Katrina Mitchell and Dr. Laurie Jones in Sedona, AZ where they recorded the podcast for IABLE. The doctors’ three children have been breastfed for cumulative length of 14 years!

– Helen M. Johnson, MD is a general surgery resident at East Carolina University / Vidant Medical Center in Greenville, North Carolina. She is originally from Tampa, Florida and obtained her medical degree from the Warren Alpert Medical School of Brown University. Dr. Johnson plans to pursue fellowship training in breast surgical oncology after graduation from residency. She has a special interest in the intersection of breast cancer and breastfeeding, and is working towards IBCLC certification. Dr. Johnson enjoys gardening, playing the cello, and spending time with her husband, two children, and beloved cat. Connect with Dr. Johnson on Twitter: @HelenMJohnsonMD

Blog posts reflect the opinions of individual authors, not ABM as a whole.