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Jun 07, 2023

Breastfeeding Disasters and Solutions for EPs : Emergency Medicine News

Abramoff, Claire MD EDs can be allies by providing space, time, and support for

Abramoff, Claire MD

EDs can be allies by providing space, time, and support for breastfeeding physician-mothers

It's 2 a.m., and I'm half-naked pumping in the call room adjacent to the trauma bay when in walks the entire trauma team—the chief of trauma surgery, several residents, and assorted medical students. Shockingly, this was probably not my most embarrassing breastfeeding scene.

I have breastfed and pumped for three children for more than 40 months in my career, 12 of those as a resident. I have pumped at eight hospitals in three states, in my current department's lactation room, empty patient rooms, call rooms, supply closets, my car, NICU lactation rooms, bathrooms, and in front of my entire team in the ED.

The American Academy of Pediatrics recommends breastfeeding exclusively for at least six months and encourages breastfeeding in addition to solid food for more than 12 months. (June 27, 2022; http://bit.ly/3YyG0WT.) Data suggest that breastfeeding decreases sudden infant deaths, childhood obesity, and asthma. Some data also suggest decreased rates of diabetes and certain types of breast and ovarian cancer. (Centers for Disease Control and Prevention. July 2014; https://bit.ly/3HKDTIL.)

But breastfeeding is hard. About 80 percent of U.S. mothers start breastfeeding, but only 20 percent are still exclusively breastfeeding six months later. There are many reasons for this: It is hard (and can be painful), the United States lacks paid parental leave, and women face tremendous challenges pumping once they are back at work.

Pumping at work is incredibly frustrating. "Pumping is a private struggle endured by millions of new mothers as they face a society unprepared—and often unwilling—to accommodate them," according to Harper's Bazaar. (July 17, 2018; http://bit.ly/3HLZZdX.) If you do not pump on a regular schedule (every two to four hours for 15 to 30 minutes), you can face painful consequences: engorgement, leaking, clogged ducts, mastitis, and abscesses. You can even lose your milk supply.

One study found 57 percent of new physician-mothers aimed to breastfeed for a year, but only 34 percent were able to. (Breastfeeding Med. 2013;8[1]31; https://bit.ly/3JSLjwj.) Half stopped due to demands at work. Emergency medicine makes breastfeeding and pumping uniquely challenging: inadequate physical space in the ED for a lactation room, unpredictable high-acuity patients, and no scheduled breaks.

Your ED can take simple steps to become lactation-friendly. The Affordable Care Act spells out the minimum requirements: a private, sanitary, non-bathroom space close to the workplace and reasonable break times for pumping. (U.S. Department of Labor. http://bit.ly/3YDlEfl.) Hospitals with residencies are required by the ACGME Common Program Requirements to have clean, private facilities for lactation with a refrigerator and proximity appropriate for safe patient care. (2018; https://bit.ly/3IiBuXv.) And ACEP finally recommended in 2013 "the availability of a private, non-bathroom area for breastfeeding emergency department employees, nurses, and physicians to express breast milk during their workday inside or directly proximal to the emergency department." (February 2020; http://bit.ly/3I9A9Cc.)

Proximity is key. A patient with a gunshot wound can walk in at any minute, and the attending physician cannot be pumping in the NICU lactation room four floors up. The first step to being a lactation-friendly ED is to make sure it has a pumping room with a door that locks, a chair, outlets, and a refrigerator. You could even put a computer in there so EPs can chart while they pump. The department could also consider renting or buying a hospital-grade pump.

EDs can also offer flexible scheduling for returning parents. Not scheduling new parents for single-coverage shifts prevents the anxiety of a code coming in while pumping. It can also be helpful to create a policy that lactating physicians can reference when they get pushback for stepping aside to pump.

These tips and tricks allowed me to breastfeed while working as an EP (Harvard Business Review. April 30, 2019; http://bit.ly/3JSUo8s; Ann Emerg Med. 2020;75[6]:681; https://bit.ly/3DTwlT0):

Being a woman in medicine, particularly a mother in medicine, is hard, and we all know about gender disparity in medicine. One report said female physicians have higher rates of burnout, lower rates of professional fulfillment, and higher rates of depression compared with their male colleagues. (Harvard Business Review. Jan. 19, 2022; https://bit.ly/3DSNBYn.) Having children only further widens the gender gap. (JAMA Network Open. 2020;3[9]:e2021061; https://bit.ly/3HL0MvR.)

Studies show that parenthood in medicine leads to reduced income, fewer work hours, and less early career retention. Female physicians often carry the burden of child care and home responsibilities, and adding a pandemic to the mix only made the disparities more glaring. Physician-mothers were 25 times more likely to manage schooling and child care than physician-fathers during the pandemic. (JAMA Network Open. 2021;4[11]:e2134315; http://bit.ly/3YenIu9.) Adding breastfeeding and its inherent stress only makes everything harder.

Lift up our colleagues by letting them pump. Don't make negative comments about your colleagues "taking breaks" or scorn them for not picking up new patients. A simple statement, "I'm impressed by how hard you are working to balance breastfeeding and working!" would have comforted me so much when the thought of pumping was overwhelming.

If you are an attending at a teaching site and know your residents or medical students need to pump, please do not make them ask you to leave. It can be humiliating and hard to tell a senior attending that you have to go pump, especially when they stare at you blankly, and you have to clarify, "Pump my breasts. Breastfeed. Make breast milk." Tell them at the start of the shift to step aside to pump whenever they need to and just make sure they alert someone. Normalize the act of pump breaks.

DR. ABRAMOFF is an assistant director for the emergency medicine residency at Einstein Medical Center in Philadelphia and a mother of three energetic kids. Follow her on Twitter @clairento.

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