Pediatricians are often among the biggest advocates for mothers who want to breastfeed – whether a patient's mom would like to continue nursing for a month or two years.

But doctors who happen to be mothers themselves know all too well how challenging it can be to follow their own advice.

While physician mothers have some of the highest rates of initiating breastfeeding, their rates of continuing to breastfeed for 12 months drops sharply from 97% to 34% – and less than a third reach their breastfeeding goals.

Common barriers include finding time and a place to express milk while at work, competing demands from work and family and taking breaks from patient care, teaching and research to pump during work hours.

Recognizing these challenges in the hospital care setting, four pediatrician mothers at University of Michigan C.S. Mott Children's Hospital have developed a model to help hospitals around the country better support breastfeeding physicians.

They published about their successful efforts to implement formalized policies around breastfeeding at work – from departments dedicating lactation times and places to supervisors engaging in dialogue with returning-to-work moms – in The Journal of Pediatrics.

"Pediatricians are natural leaders to champion and support lactating mothers both in our clinical care and in the workplace," says lead author Megan Pesch, M.D., a developmental behavioral pediatrician at Mott who has breastfed all three of her children ages four, two, and 11 months old.

"As pediatricians, we are educated on the importance of breastfeeding, and many of us work hard to support mothers in achieving their breastfeeding goals. Ironically, the same doctors who so vigorously provide this support to patients face significant obstacles to meeting breastfeeding goals with their own babies."

Pesch says physician moms often struggle balancing patient care with lactating breaks, especially those who may work in the operating room.

And trainees –  including students, residents, and fellows – are particularly vulnerable because they have less control over their schedules, work longer hours, and are away from their infants for longer stretches of time, authors note. Trainees may also have a more difficult time advocating for themselves with senior faculty. Previous studies suggest that only 10% of pediatric training programs have policies to support lactating residents.

Such factors may increase the likelihood that doctors skip "pump breaks," which can lead to blocked ducts, mastitis (breast infection), decreased milk supply, feelings of inadequacy, stress, and burnout, Pesch says.

"When physicians take a break, it may affect colleagues, or disrupt work that cannot continue without them. These doctors may experience a double burden of guilt over letting down team members by taking pump breaks that might affect someone else's workload and a team's ability to meet patient care demands," Pesch says.  

Promoting a culture that supports breastfeeding physicians

Pesch and fellow pediatrician mothers Sarah Tomlinson, M.D., Kanakadurga Singer, M.D., and Heather L. Burrows, M.D., Ph.D., came together to develop a model they hope others will implement.

Although many departments and supervisors already support lactating physician mothers, Pesch notes that physicians are often uncomfortable talking about breastfeeding or initiating breaks.

Having a straightforward policy can prevent discrimination and educate returning physician mothers as well as supervisors, she says. Supervisors should also consider scheduling and actively helping trainees to identify times they can take breaks to pump, she says.

"Our workforce in pediatrics is majority female and most of us complete training or work during childbearing years," Pesch says.

"The practices we recommend may already be accepted by many health care environments, but formalizing them through a policy is imperative to promote a culture of acceptance and encouragement of breastfeeding."

Pesch and colleagues suggest four key elements all health care setting lactation policies should include:

A dedicated time to express milk. Protections and provisions should be made to set aside blocks of time for milk expression. One example is dedicating a 15-minute period out of every 4-hour block spent in clinical duties, including clinic, floor work, and procedural work. Trainees often have midday educational activities, and they shouldn't need to choose between milk expression and their education.

A dedicated place to express milk. Lactating individuals should have access to a private, clean, non-bathroom location to express milk. Ideally, a busy physician should have access to a room with a phone and computer to continue working if she so chooses.

A dedicated place to store milk. Human milk should be considered a regular food product and there should be support in storing milk in areas where employee food may also be stored.

An open culture of communication around lactation. Support for program directors, supervisors, and colleagues in engaging in a dialogue around lactation is essential to help address this need, especially for trainees.

"The support and encouragement provided to breastfeeding physicians has improved over the last several decades, but there is still a long way to go," Pesch says.

"A workplace culture of support for breastfeeding should empower physician mothers to take the time they need to meet breastfeeding goals. Supporting breastfeeding physicians not only benefits their infants, but promotes the well-being of the physician mother and workplace wellness – which may contribute to improved patient care."

Paper cited: Pesch, M., Tomlinson, S., Singer, K., Burrows, H., et al. "Pediatricians Advocating Breastfeeding: Let's Start with Supporting
our Fellow Pediatricians First" The Journal of Pediatrics. DOI: 10.1016/j.jpeds.2018.12.057