Editor’s note: The opinions expressed by the author does not necessarily reflect the views of the AAMC or its members.
I had high hopes that the day would go well. It was my third day on a hematology/oncology rotation, and I was finally starting to get the routine down. Even better, I felt like I was handling the pressures of being a third-year medical student and a new mom with reasonable grace. As I left home, I was confident that I had a good four hours before I’d need to express my breast milk, and I figured I could squeeze in a few minutes before a lunchtime meeting. Unfortunately, it turned out I had been much too optimistic.
My breasts were already sore as I ran down the stairs trying to make it to the meeting on time. I quickly slipped into a corner behind all the attendings, hoping to go unnoticed if I started to leak milk. But soon I glanced down to find a large, wet stain spreading across the front of my silk blouse. Then matters got much worse: My attending called on me and the other student to present about a potential transplant patient. As all the heads in the room swiveled toward us, I was flooded with embarrassment. I managed to squeak out a few words about the case while scrambling to cover up my wet chest with my white coat.
This was just one of many dismaying moments I’ve suffered while training to be a doctor and breastfeeding my children.
More than 80% of [medical trainees] reported feeling stressed about breastfeeding, and one-third did not meet their breastfeeding goal.
Certainly, many other medical moms have endured similar experiences. In fact, nearly half of physician mothers say they stopped breastfeeding sooner than planned because of work-related issues. The challenges they reported most frequently included inadequate time, inflexible schedules, and insufficient space.
In a survey of 412 medical trainees with children, more than 80% of women reported feeling stressed about breastfeeding, and one-third did not meet their breastfeeding goal. Among other concerns, they reported getting too little support from their colleagues and institutions. What’s more, some said their own frustration with breastfeeding made them less likely to recommend breastfeeding to their patients.
The benefits of breastfeeding for the health of the infant and mother are well-established. So the question remains: What kind of experience do we want for our future physicians, and what are we willing to do to achieve it?
Out of the (supply) closet
Self-advocacy is challenging for most medical students given that we sit on the lowest rungs of the care team ladder. Advocating for the supports needed to breastfeed can feel like a painful extra reach.
As a third-year student just starting clerkship rotations, I often felt inexperienced, out of place, and inefficient. I wore a white coat to blend in with the team, but a shorter one so that I would stand out from residents, fellows, and attendings. Then when I became a new parent six months ago, I began to feel even more isolated. Few residents have children, and even fewer medical students do. All the factors eroding my confidence and sense of connection likely contributed to my discomfort in making pumping-related requests.
I told the first attending I worked with after giving birth that I’d need to pump every few hours, but I still felt uncomfortable asking for extra time off every time I saw him. I worried that skipping opportunities for education or patient care would be viewed as a lack of interest and would show up in my final performance reviews. So after that first rotation, I often chose not to tell my team I was breastfeeding or mention pumping.
Instead, I'd regularly lug around my pumping gear, slipping off to a public bathroom or a supply closet for a precious five or 10 minutes — much less than the recommended 20 to 30 minutes necessary for maintaining a healthy milk supply. I would contort my lap into a shelf where I would balance my pump and collection bottles, all the while praying I would not drop anything. If a semiclean surface was available, I would hunch over it, bracing my collecting bottles to my breasts, wishing I had an extra hand so I could use the time to look up recommended first-line therapies for the patient I had just seen.
I developed a sixth sense for other moms with young children. I would soon grill them on their experience, hoping they could recommend a good pumping space or a smart way to raise the topic with their team. I was more than a little disheartened when most of the stories they shared were negative.
One fellow medical student reported that she often would have to pump during a lunchtime didactic session, which clearly made at least one of the other students uncomfortable since someone complained to the clerkship director.
More than half of today’s medical students are female. Let's not make any new mothers among them choose between promoting their professional lives and breastfeeding their babies.
Another mom told me about her struggles during a clerkship that required travel to a different outpatient office every day. Because her routine changed frequently, she could not predict when she’d have time to pump, and she often found that sites had no dedicated lactation space. Each day was a battle for her, and she stopped breastfeeding during that clerkship.
It's a great irony that institutions on the forefront of promoting health care don’t do enough to prevent these and many other women from abandoning breastfeeding prematurely. Leaders in academic medicine need to step up and do much more to help protect the well-being of mothers, babies, and all of society.
Steps that support breastfeeding
There are many ways to create physical and emotional environments that promote trainee breastfeeding. The Accreditation Council for Graduate Medical Education describes necessary conditions for residency programs, and a study on work and breastfeeding points to factors that contribute to continued lactation, including longer maternity leaves.
A model policy on breastfeeding and medical trainees from the American Academy of Family Physicians outlines several detailed suggestions. These include:
- Creating appropriate lactation facilities: The goal is to provide clean, private, and comfortable lactation rooms. These should be conveniently located and provide a place to store milk. Ideally, the spaces would also offer access to computers to make it possible to work while pumping.
- Providing adequate time: Institutions should arrange for breaks that last 20 to 30 minutes for up to a year after birth. Supervisors should work to notify others affected by trainees’ breaks and provide the necessary support. Also desirable is offering lactating mothers less-demanding rotations upon return after maternity leave.
- Creating a supportive culture: To create a supportive culture, institutions should advise trainees of available resources through regular education efforts. Such efforts should disseminate information about the institution’s breastfeeding policy and the location of lactation rooms. In addition, employees should also receive training on the importance of breastfeeding for health and well-being.
It is essential that we shift the culture away from one that too often makes breastfeeding trainees feel isolated and overextended. Instead, breastfeeding should be honored and encouraged for future physicians as much as it is for our patients. More than half of today’s medical students are female. Let's not make any new mothers among them choose between promoting their professional lives and breastfeeding their babies.