Barriers to Breastfeeding in Female Physicians

Code Milk: Finding the Pulse of Lactation Culture, Practices, and Preferences of Pediatric Emergency Medicine Fellows

OBJECTIVES

The aim of the study is to characterize the lactation goals and practice of pediatric emergency medicine (PEM) fellows and to identify areas of improvement related to 1) policy awareness, 2) departmental culture and accommodations, and 3) lactation space and time.

METHODS

This study is a national, cross-sectional survey study of PEM fellows and program directors (PDs). Two surveys were developed via iterative review and distributed by the PEM-PD Survey Committee. Responses were collected anonymously via the Qualtrics survey platform. Data were summarized using descriptive statistics.

RESULTS

Survey responses from 60 PEM PDs (71%, 60/84) estimated that 67% (310/461) of their fellows had the ability to lactate. One hundred fifteen study-eligible fellows (37%) completed the survey. Most fellows (57%, 66/115) reported having lactated or expected to lactate during fellowship. Fellows reported an ideal lactation time of 11.5 months. Sixty-two percent (8/13) met their lactation goal and 42% (22/66) did not or did not know if they would meet their goal. Forty-three percent (50/115) of fellows and 57% (34/60) of PDs were aware of workplace lactation policies. Sixty-one percent (38/62) of fellows discussed a lactation plan with their PDs and 18% (7/39) reported their rotations upon returning to work were scheduled with lactation needs in mind. A dedicated lactation space was available to 67% (43/64) of fellows but used by 29% (11/28). Fellows lactated on average twice during an 8-hour shift, spending 7 minutes walking to and from their chosen lactation space and 21-minute pumping per session.

CONCLUSIONS

PEM fellows are likely to have lactation needs during fellowship but receive inconsistent support from their programs. Based on our findings, we advocate for the creation of more visible and PEM-specific workplace lactation policies, planning with PDs pre-return to work, and improved availability and usability of designated lactation spaces. Further optimization may help support PEM fellows' personal, clinical, and academic productivity.

Return to work after parenting in thoracic surgery: a call to action

OBJECTIVES

Women in our modern era are facing considerable challenges in the workplace, particularly in Cardiothoracic Surgery where women are under-represented in leadership and academic roles. Returning to work after parental leave may potentially uncover or exacerbate existing gender biases within the workplace, with important consequences on professional and personal lives. Our goal was to characterize the experiences and the impact of return-to-work after parenting on Thoracic Surgery careers across Europe.

METHODS

All the participants of the European Society of Thoracic Surgeons Annual Meeting in 2023 were invited to complete this 32-item questionnaire. The survey was subsequently distributed through the European Society of Thoracic Surgeons social media platform from November to January 2024. A descriptive and specific group analysis was performed according to the distribution.

RESULTS

There were 152 participants, 92 of whom were female (61.0%) and 66 (43%) were between 31 and 40 years, constituting the most heavily represented age group. More women parents reported their role as the primary care provider of their child (89% vs 34%; P < 0.00001). Moreover, presence of in-hospital childcare facilities was evaluated as more important by women. Approximately half of the parent-respondents reported breastfeeding (42, 52%), but only 26% (11) of this group indicated having any type of flexible hours for breast-feeding. Compared to men, women more often agreed that parenting might affect their career (81% vs 53%; P = 0.040) and felt less supported by their employers when having children (45% vs 68%; P = 0.37).

CONCLUSIONS

This survey study identified main challenges to return to surgical work after parental leaves. Lack of structural or system-level support and limited resources for childcare and breastfeeding were considerably affecting women surgeons. Institutional initiatives for new parents and breast-feeding colleagues are crucial for supporting a diverse workforce, and any kind of discrimination derived from parental leaves should not be tolerated.

Challenges and Choices in Breastfeeding Healthy, Sick and Preterm Babies: Review

Although breastfeeding is associated with many health-related benefits for both mothers and children, the WHO recommendation for exclusive breastfeeding is not achieved by the majority in any WHO region. This paper aims to present the current state of research on challenges and choices in breastfeeding healthy, sick and preterm babies. The research was organized as a systematic search in PubMed and the study was performed as a narrative review after applying the PRISMA protocol. Finally, n = 57 studies were included. Both barriers and support factors emerge as a complex interaction of individual, group and societal factors, the precise understanding of which is relevant to increasing breastfeeding rates in the future. Knowledge as well as practical skills proved to be generally helpful, whereas the lack of breastfeeding support for mothers, who are often separated from their premature babies in hospital, was identified as a key risk factor for this subgroup. Appropriate training for healthcare professionals can improve the situation as a result. After discharge, workplace-related barriers are of major concern to allow further breastfeeding when maternity leave ends. Thus, the promotion of breastfeeding must be perceived as a task for society as a whole.

Challenges of Motherhood for Anesthesiologists: A Scoping Review

Despite advancements in gender representation, female anesthesiologists continue to encounter challenges in career advancement that may be further impacted by motherhood. This scoping review examines personal and systemic barriers and facilitators to career advancement for anesthesiologists facing infertility, pregnancy, and childcare. The review identified 22 relevant studies across five themes: the timing of pregnancy and parental leave, breastfeeding and lactation needs, childcare and gender norms, job reentry and career advancement opportunities, and work-life balance and physician well-being. Recommendations from these studies include establishing clear parental leave policies, providing adequate lactation spaces and protected break times, addressing gender disparities in leadership roles, and prioritizing physician well-being. To implement these recommendations effectively, institutions and departments should develop and disseminate role-specific policies that promote career advancement and satisfaction through equitable support of pregnant and parent anesthesiologists.

Creating a national breastfeeding and lactation policy for Canadian surgical residents

Background

Despite known benefits of breastfeeding and challenges medical trainees face lactating at work, research specific to Canadian surgical trainees is lacking. Our objectives were to examine existing breastfeeding and lactation policies, query experiences and opinions of surgical trainees and program directors, and propose a comprehensive policy for programs nation-wide.

Methods

A multi-disciplinary team developed this two-part study. The scoping review used database and grey literature searches to find North American policies covering surgical residents. The survey study queried lactating Canadian surgical trainees and program directors about experiences and barriers, support provided, and interest in a breastfeeding and lactation policy.

Results

Ten policies were found. None comprehensively addressed lactation space and supplies, break times, supports, and resident responsibilities. Among ten PD survey respondents: 60% were female, 70% had lactating trainees during their tenure, 40% discussed lactation accommodations, and all were willing to instate a policy. Among 24 trainees: 45% met breastfeeding goals, 74% stopped breastfeeding prematurely due to work barriers, and 88% had little workplace support. Almost all trainees (96%) wanted a policy.

Conclusion

There is opportunity and appetite for a more comprehensive breastfeeding and lactation policy for Canadian surgical residents. Our policy highlights important areas where trainees can be better supported to meet breastfeeding goals.

Contexte

Malgré les avantages bien établis de l'allaitement et les difficultés auxquelles les apprenants en médecine sont confrontés pour allaiter sur leur lieu de travail, il n'existe aucune recherche spécifique qui concerne les apprenants en chirurgie au Canada. Nos objectifs étaient d'examiner les politiques existantes en matière d'allaitement et de lactation, d'interroger les expériences et opinions des apprenants en chirurgie et des directeurs de programmes, et de proposer une politique globale à l'échelle nationale.

Méthodes

Une équipe multidisciplinaire a développé cette étude qui comporte deux parties. L'examen de la portée s'est réalisée à l'aide des bases de données et de la littérature grise pour identifier les politiques nord-américaines relatives aux résidents en chirurgie. L'étude par sondage a permis de recueillir les expériences des apprenants en chirurgie canadiens qui allaitent, ainsi que les avis des directeurs de programmes sur les obstacles rencontrés, le soutien fourni et l'intérêt pour une politique d'allaitement et de lactation.

Résultats

Dix politiques ont été identifiées. Aucune ne couvrait de manière exhaustive les aspects relatifs à l'espace et aux fournitures d'allaitement, aux temps de pause, aux soutiens, et aux responsabilités des résidents. Parmi les dix directeurs de programmes ayant répondu au sondage : 60 % étaient des femmes, 70 % avaient encadré des résidents allaitant, 40 % avaient abordé la question des aménagements pour l'allaitement, et tous étaient favorables à l'instauration d'une politique. Parmi les 24 résidents interrogés : 45 % ont atteint leurs objectifs d'allaitement, 74 % ont cessé d'allaiter prématurément en raison d'obstacles professionnels, et 88 % ont signalé un faible soutien sur leur lieu de travail. Presque tous les résidents (96 %) étaient favorables à l'élaboration d'une politique.

Conclusion

Il existe une opportunité et un besoin pour une politique plus complète en matière d'allaitement et de lactation pour les résidents en chirurgie au Canada. Notre politique met en lumière les domaines clés où les résidents pourraient être mieux soutenus pour atteindre leurs objectifs d'allaitement.

One Pump at a Time: A Wearable Lactation Pump Pilot for Graduate Medical Education Trainees

Background: Despite the known benefits of lactation, lactating graduate medical education (GME) trainees encounter difficulties when returning to work. Wearable lactation pumps are known to be beneficial in lactating physicians, but the benefit for GME trainees in clinical care and education has not been explored. Objectives: The objective of this study was to examine the benefits of wearable lactation pumps on education and clinical care for GME trainees. Methods: In 2022-2023, all lactating GME trainees at a large academic center were invited to participate in a wearable pump pilot. Participants completed six baseline surveys with questions on lactation practices and individuals' perceptions before receiving the pump, repeated the six surveys after receiving the pump, and completed a monthly survey for 6 months after receiving the pump. A linear mixed methods model was used to compare reported experiences before and after receiving the wearable pump. Results: Twelve trainees participated in the pilot, with 10 completing pre- and post-surveys. When compared with experiences before receiving the wearable pump, there was a significant decrease in the perceived impact of lactation on clinical care (p = 0.03), medical education (p = 0.004), and missed pumping sessions (p = 0.02) after using the wearable pump. All participants who used the wearable pumps reported that it helped them to meet lactation goals. Conclusions: Wearable pumps are beneficial to trainees and may decrease the barriers to education and clinical care. GME sponsored pump programs may better support lactating trainees on their return to work.

Occupational Factors Associated With Time to Breastfeeding Discontinuation After Return to Work Among Female Anesthesiologists in China: A Nationwide Survey

BACKGROUND

Breast milk is of great benefit to both infants and mothers. Due to occupational barriers, female physicians are at high risk of unintentionally discontinuing breastfeeding. However, evidence among anesthesiologists was limited. The purpose of this study was to investigate occupational factors associated with time to breastfeeding discontinuation among female anesthesiologists following maternity leave in China.

METHODS

We conducted a nationwide survey of female anesthesiologists who had given birth since January 1, 2015. A 60-item anonymous questionnaire was developed to collect information regarding breastfeeding practices and related factors. The questionnaire was revised based on the recommendations of 15 experts and feedback from the pilot survey. The survey was distributed by the Chinese Society of Anesthesiology.

RESULTS

The completion rate was 57.9%. In total, 1364 responders were analyzed from all 31 provinces of Mainland China. In total, 1311 (96.1%) responders reported a reduction in breast milk supply on returning to work. Among the 1161 responders who discontinued breastfeeding, 836 (72.0%) did not achieve desired goals due to occupational factors. The median [interquartile range] of maternity leave length and breastfeeding duration were 5 [4-6] months and 10 [7-12] months, respectively. The following occupational factors were associated with longer time to breastfeeding discontinuation after adjusting for confounding effects of personal factors: length of maternity leave (hazard ratio [HR] per month 0.44; 95% confidence interval [CI], 0.36-0.54; P < .001), pumping breast milk during work time (HR, 0.04; 95% CI, 0.02-0.08; P < .001), support from colleagues (HR, 0.92; 95% CI, 0.86-0.99; P = .032), and additional nonclinical activities (HR, 0.87; 95% CI, 0.77-0.98; P = .022). Trainees under supervision (HR, 1.20; 95% CI, 1.06-1.43; P = .005) and the need to remain in the operating room during cases (HR, 2.59; 95% CI, 1.09-6.12; P = .031) were associated with shorter time to breastfeeding discontinuation. Approximately 899 (65.9%) responders pumped breast milk during work time. Among them, reduction in pumping frequency (HR, 1.17; 95% CI, 1.00-1.36; P = .049) and difficulty in finding opportunities for pumping (HR, 2.34; 95% CI, 1.36-4.03; P = .002) were associated with shorter time to breastfeeding discontinuation.

CONCLUSIONS

We identified modifiable occupational factors associated with time to breastfeeding discontinuation. These findings underscored the necessity of facilitating breastfeeding in the workplace, including encouraging longer maternity leave and breastfeeding breaks, considering the feasibility of pumping in daily case assignments, establishing supportive culture, providing lactation rooms, and offering nonclinical activities.

Barriers to Breastfeeding During Surgery Residency

OBJECTIVE

Breastfeeding is a highly demanding experience, especially for surgical residents who pump after returning to work. We believe that there are obstacles to pumping and opportunities exist to improve support for this group. The objective of this study was to understand the experience of breastfeeding surgery residents and find opportunities for increased support.

DESIGN

Surveys were sent out through the Association of Program Directors in Surgery for distribution among current residents. A survey was also conducted in a private group of surgeon mothers to identify those who had previously been breastfeeding during residency.

SETTING

All surveys were performed online with results collected in a REDCap web-based application.

PARTICIPANTS

Participants were those who gave birth during their surgical residency.

RESULTS

67% of the 246 survey respondents stated that they did not have adequate time for pumping and 56% rarely had access to a lactation room. 69% of mothers reported a reduction in milk supply and 64% stated that the time constraints of residency shortened the total duration they breastfed. 59% of women did not feel comfortable asking to pump.

CONCLUSIONS

Surgical residents reported a lack of space, resources, and dedicated time for pumping. These deficiencies contribute to shorter breastfeeding duration. It is crucial to provide lactation rooms and to foster a supportive culture.

A qualitative analysis of the breastfeeding experiences of mothers who are nurses and nutritionists

BACKGROUND

From a medical standpoint, breastmilk is the optimal option for feeding a baby, relegating the cultural, social, and material determinants to breastfeeding. Worldwide, breastfeeding rates are low, especially among working mothers. Healthcare providers have low breastfeeding rates due to several barriers to lactation, i.e. work schedule andlack of private places for pumping.

METHOD

A descriptive qualitative methodology was applied to examine the breastfeeding experiences of Ecuadorian mothers who are healthcare professionals. Twenty healthcare professionals who breastfed their babies took part in the research. Data gathering employed synchronous semi-structured interviews in Spanish. The data analysis followed the Phronetic Iterative Approach.

RESULTS

Women shifted the preconceived idea of the ideal breastfeeding scenario concerning duration, promotion, and support, ideals which are constructed in their training as healthcare professionals. Although these women believe that breast milk and breastfeeding is the best way to feed a baby, the internalized ideal of breastfeeding shifted with the experience of motherhood. Although they had that clash between the ideal and the external reality, they continued breastfeeding their babies, and those experiences resulted in them improving their professional practice.

CONCLUSIONS

This study demonstrated that breastfeeding for this group of women appears to be a unique relational and identity negotiation process. The findings emphasize that experiencing breastfeeding for this group of healthcare providers positively shifted how they communicate breastfeeding with their patients in the clinical encounter. Ensuring that healthcare professionals acquire a different approach for educating and communicating about lactation is an essential determinant in efforts to improve breastfeeding rates in Ecuador.

Physician personal breastfeeding experience and clinical care of the breastfeeding dyad

BACKGROUND

Prior research suggests that physicians' personal experience with breastfeeding may influence their attitudes toward breastfeeding. This phenomenon has not been explored in well-newborn care physician leaders, whose administrative responsibilities often include drafting and approval of hospital breastfeeding and formula supplementation policies.

METHODS

We conducted a mixed-methods study, surveying physicians in the Better Outcomes through Research for Newborns (BORN) network. We examined physician attitudes toward recommending breastfeeding and their breastfeeding experience. Qualitative analysis was conducted on responses to the question: "How do you think your breastfeeding experience influences your clinical practice?"

RESULTS

Of 71 participants, most (92%) had a very positive attitude toward breastfeeding with 75% of respondents reporting personal experience with breastfeeding. Of these, 68% had a very positive experience, 25% had a somewhat positive experience, and 6% had a neutral experience. Four themes emerged with respect to the effect of breastfeeding experience on practice: (1) empathy with breastfeeding struggles, (2) increased knowledge and skills, (3) passion for breastfeeding benefits, and (4) application of personal experience in lieu of evidence-based medicine, particularly among those who struggled with breastfeeding.

CONCLUSIONS

Well-newborn care physician leaders reported positive attitudes about breastfeeding, increased support toward breastfeeding persons, and a perception of improved clinical lactation skills. Those who struggled with breastfeeding reported increased comfort with recommending formula supplementation to their own patients. Medical education about evidence-based breastfeeding support practices and provision of lactation support to physicians has the potential to affect public health through improved care for the patients they serve.

Exploring workplace barriers faced by breastfeeding mothers who are PAs

OBJECTIVES

To explore physician associate/assistant (PA) mothers' breastfeeding intention, duration, as well as workplace barriers for breastfeeding among working PA mothers and to determine if specialty has an effect on breastfeeding duration.

METHODS

A cross-sectional online survey was administered to PA mothers who had at least one biological child while a PA student or practicing as a PA. Study participants were recruited through the American Academy of Physician Associates' special interest group, PA Moms.

RESULTS

The 545 participants reported a breastfeeding goal of 12 months in 76.8% of births. Breastfeeding rates among participants were 96.3% at birth, 83.8% at age 3 months, 78.1% at age 6 months, and 54.8% at age 12 months. Exclusive breastfeeding rates were 77.9% at birth, 75% at age 3 months, and 42.6% at age 6 months. Workplace support from colleagues and support staff was associated with longer exclusive breastfeeding duration and any breastfeeding duration. Adequate time and place for expression of breastmilk and support from supervising or collaborating physicians were associated with longer duration of breastfeeding. Specialty had a statistically significant effect on exclusive breastfeeding duration.

CONCLUSIONS

PA mothers failed to meet their breastfeeding goals, despite high initiation rates. Dedicated time and space to express breastmilk and workplace support may significantly improve PA mothers' breastfeeding duration.

Determinants of health care worker breastfeeding experience and practices and their association with provision of care for breastfeeding mothers: a mixed-methods study from Northern Thailand

BACKGROUND

Improving breastfeeding rates is one of the most cost-effective ways to prevent infant deaths, but most of the world falls far below WHO recommended breastfeeding practices. Confident, informed healthcare workers are an important resource to promote breastfeeding, but healthcare workers are at risk of early breastfeeding cessation themselves. Culture, ethnicity and socio-economic status impact breastfeeding rates with some of the highest and lowest rates in Southeast Asia reported from Thailand. This study explores the relationship between workplace determinants of breastfeeding, personal breastfeeding outcomes for healthcare workers, and the breastfeeding care healthcare workers provide their patients.

METHODS

This study used a sequential exploratory design guided by a conceptual framework based on social ecological/ecological psychology models. Participants came from four clinical sites in Northern Thailand, from ethnically Burman or Karen communities with high breastfeeding rates, and Thai communities with low breastfeeding rates. In-depth interviews (July 2020-November 2020) were followed by a quantitative survey (November 2020-July 2021) derived from validated questionnaires (Australian Breastfeeding Knowledge and Attitudes Questionnaire and the Workplace Breastfeeding Support Scale) with minor local adaptations.

RESULTS

Interviews highlighted the beneficial effects of supportive workplace policies, the importance of physical spaces to facilitate proximity between mothers and infants, and the problem of low milk production. Meeting the WHO recommended practices of exclusive breastfeeding to 6 months or total breastfeeding to 2 years or more was more common in sites with higher levels of breastfeeding support (aOR 7.3, 95%CI 1.8, 29.1 for exclusive breastfeeding). Exclusive breastfeeding was also higher when staff set breastfeeding goals (aOR 4.4, 95%CI 1.7, 11.5). Staff who were able to see their infants during the work day were less likely to terminate breastfeeding because of work (aOR 0.3, 95%CI 0.1, 0.8). Staff who met both WHO recommendations themselves were more likely to report high levels of confidence caring for breastfeeding patients (aOR 2.6, 95%CI 1.1, 6.4).

CONCLUSIONS

Workplace protections including supportive maternity leave policies and child-friendly spaces can improve breastfeeding outcomes for healthcare workers. These improved outcomes are then passed on to patients who benefit from healthcare workers who are more confident and attentive to breastfeeding problems.

Parental leave during pediatric fellowship training: A national survey

BACKGROUND

Until recently, no uniform requirements for parental leave (PL) existed in graduate medical education. We implemented a national survey, with the objective of ascertaining fellows' perceptions of PL policies and their impact. This is the first study to focus exclusively on pediatric subspecialty fellows.

METHODS

An online survey instrument was created targeting pediatric fellows.

RESULTS

The survey was accessed by 1003 (25%) of the estimated 4078 pediatric subspecialty fellows and 853 (21%) submitted surveys. Respondent demographic data paralleled the data reported by the American Board of Pediatrics. Half of respondents did not know whether their program had a written PL policy. Over 40% reported ≥ 5 weeks of paid PL. Most indicated that fellows use vacation, sick leave, and unpaid time for PL. Almost half of respondents (45%) indicated that their program's PL policy increases the stress of having a child. Fellows chose establishing/extending paid leave and intentionally fostering a more supportive program culture as the most crucial candidate improvements. The importance of equitable PL polices between parent fellows and co-fellows was an important theme of our qualitative data. Fellows feel there is a moral misalignment between the field of pediatrics' dedication to maternal and child health and current PL policies governing pediatric trainees.

CONCLUSIONS

PL policies vary widely among pediatric fellowship programs and are often not known by fellows. Fellows are not satisfied with PL policies, which often exacerbate stress for new parents and burden their co-fellows. Targeted modification of several aspects of PL policies may improve their acceptance.

Breastmilk pumping experiences of physician mothers: quantitative and qualitative findings from a nationwide survey study

BACKGROUND

Nearly half of graduating medical students today are women, with many having children early in their careers, necessitating thoughtful consideration of practices and policies. The short duration of maternity leave for physician mothers often means that most who choose to breastfeed must return to work while still breastfeeding their infants.

OBJECTIVE

To characterize the experience of physician mothers and identify facilitators and barriers related to breastmilk pumping upon return to work.

DESIGN

Cross-sectional nationwide survey study administered to physician mothers electronically via REDCap™ to broadly characterize their personal experiences with family leave and return to work.

PARTICIPANTS

Physician mothers in the USA (n=724).

APPROACH/MAIN MEASURE

Demographic data and survey responses related to experiences during family leave and return to work, including free-text response options when participants indicated "other" experiences not captured by the survey response options and one open-ended question asking, "What do you think are the most important factors contributing to a positive maternity/family leave experience?" For this study, we searched free-text responses across the entire survey for keywords related to breastfeeding and pumping and thematically analyzed them to summarize key features of physician mothers' experiences.

KEY RESULTS

Lack of time, flexibility, dedicated and hygienic locations for pumping breast milk, disrespect and lack of support from others, and concerns about financial consequences of productivity changes were the most common barriers to pumping breastmilk reported by physician mothers.

CONCLUSIONS

Flexibility in scheduling, adjusted productivity targets, and clean, private, and well-equipped pumping rooms would likely provide the greatest support to help physician mothers thrive in their careers while simultaneously allowing them to provide the nourishment needed for their developing infants.

Creation of a nationwide breastfeeding policy for surgical residents: a scoping review protocol

INTRODUCTION

Breast feeding is recommended for the first year of a baby's life due to numerous benefits for both the child and mother. After returning from maternity leave, surgical trainees face extensive barriers to breast feeding and tend to terminate breast feeding earlier than guideline recommendations. The aim of this scoping review is to assess existing breastfeeding policies for surgical trainees at the national level including postgraduate medical education offices, provincial resident unions and individual surgical programmes.

METHODS AND ANALYSIS

A modified Arksey and O'Malley (2005) framework will be used. Specifically, (1) identifying the research question/s and (2) relevant studies from electronic databases and grey literature, (3) identifying and (4) selecting studies with independent verification, and (5) collating, summarising, and reporting data while having ongoing consultation between experts throughout the process. Experts will include a lactation consultant (AGB), a human resource leader (JI), a health information specialist (ES), two independent coders (NZ, LR) and a board-certified surgeon (JD). This work will take place as of December 2020 and be carried out to completion in 2021.

ETHICS AND DISSEMINATION

Ethics approval will not be sought for this scoping review. Research findings will be disseminated through publications, presentations and meetings with relevant stakeholders.

Lactation in Anesthesiology

There are several work-related barriers to breastfeeding among physician mothers including: lack of appropriate place for breastmilk expression, unpredictable and inflexible schedules, and lack of time to breastfeed or express milk. In a survey of physician mothers, those who were in surgical and procedural subspecialties, including anesthesiology, reported a lack of lactation facilities in close proximity to the operating room as a barrier to breastfeeding. Unlike other physicians and clinicians in different health care environments, anesthesiology is unique in that there is often no built-in time for breaks or a predictable end time to the operating room schedule. A break system is typically established, within an institution, for meal break relief for trainees, Certified Registered Nurse Anesthetist, and Anesthesia Assistants. This system for breaks may not be sufficient to accommodate the frequency or length required for lactation sessions. In addition, these break systems do not typically provide relief for supervising anesthesiologists for meals or lactation sessions. A study of physician mothers across specialties identified anesthesiologists as significantly more likely than women of other medical specialties to self-report maternal discrimination. The study defined maternal discrimination as discrimination based on pregnancy, maternity leave, or breastfeeding. As a workforce and specialty, we must support our breastfeeding anesthesiologists and facilitate lactation needs on return to the workplace.

The Impact of Wearable Breast Pumps on Physicians' Breastfeeding Experience and Success

Background: Physician mothers face many barriers in their ability to meet their lactation goals. This is often due to short maternity leaves and an often busy, inflexible work schedule at the time of return to work. We aimed to characterize the effect of using wireless, wearable breast pumps in the workplace and determine if these devices may help overcome barriers to breastfeeding success for physician mothers. Methods: A cross-sectional survey was distributed to female physicians and trainees identified through the group "Doctor Mothers Interested in Lactation Knowledge (Dr. MILK)" using an anonymous, Qualtrics^® survey on the group's social media site. Participants were analyzed in two groups: those who had used wearable pumps versus those who had only used traditional breast pumps. Results: Of the 542 respondents analyzed, 321 (59%) had used a wearable pump in the workplace and 221 (41%) had only used a traditional electric breast pump. Those who had used a wearable pump reported statistically significant shorter lactation breaks (p < 0.00001) and were more likely to be able to provide breast milk to their infants for their entire intended duration (p = 0.005) compared to the traditional pump group. The ability to pump as often as needed while at work (p = 0.16) and the frequency of lactation breaks throughout the day (p = 0.223) were not significantly different when comparing the two groups. Conclusions: This study demonstrates a benefit to using wearable breast pumps for women physicians as they return to work after maternity leave. Utilization of these new wearable pumps correlates with shorter lactation breaks and the ability of physician mothers to provide breast milk to their infants for their intended duration.

Childbearing in radiology training and early career: Challenges, opportunities, and finding the best time for you

For many women, radiology residency occurs during the childbearing years and they often question when is the best time to have children. Anxiety regarding fertility and pregnancy-related complications contribute to early career burnout in women physicians and many have fertility regrets. Supporting radiologists in training and early in their career as they navigate pregnancy and childbearing is critical to achieving a diverse workforce and leadership. Herein, we explore career-related challenges of childbearing and highlight opportunities for radiologists in residency, fellowship, and early in their career, so that they can make an informed childbearing decision.

Breastfeeding Advocacy: A Look into the Gap Between Breastfeeding Support Guidelines and Personal Breastfeeding Experiences of Faculty Physicians

Objectives: Despite increased lactation support for mothers over the past few decades, physician mothers still face considerable challenges to achieving their breastfeeding goals. Disparities in breastfeeding exist between physician and nonphysician mothers in the United States. To formulate an effective advocacy agenda for this population, we surveyed faculty physician mothers about their breastfeeding experiences. We hypothesized that identifying frequent, modifiable barriers to breastfeeding could generate ideas for improved lactation support for female physicians. Study Design: A deidentified breastfeeding survey was sent to female faculty physicians at an academic children's hospital in 2020. Inclusion criteria included female faculty physicians who had given birth within the past 5 years. The responses of those who selected "yes" when asked if they had breastfed were analyzed. Results: Fifteen percent of respondents stated that they did not meet their breastfeeding goals. The most prevalent theme for both positive and negative factors in the qualitative analysis was pumping breast milk. Physician mothers provided key insight into (1) the impact of their role as physicians on their breastfeeding experience, (2) impact of their return to work on breastfeeding, and (3) ideas for improved lactation support. Conclusion: This study highlights the need to improve maternal and infant health by advocating for faculty physicians who are providing breast milk for their children. Advocacy efforts should focus on improving conditions for breast milk pumping and for effective policies around return to work after delivery. Further development and study of individualized breastfeeding support plans for physician mothers is needed.

Promoting Lactation Support: Challenges and Solutions to Supporting Breastfeeding Radiologists

RATIONALE AND OBJECTIVES

Although the evidence for the benefits of breastfeeding is strong, parents are often unable to continue breastfeeding upon returning from maternity leave for a variety of reasons. Breastfeeding parents in medicine face unique challenges upon returning to the workforce after maternity leave. Current research on breastfeeding radiologists is limited. The objective of this research is to evaluate breastfeeding barriers and identify potential solutions to help radiologists reach their breastfeeding goals.

MATERIALS AND METHODS

A 17-question survey was developed from validated surveys and pilot tested using focus groups. The survey was emailed to members of the American Association for Women in Radiology and promoted through social media. Bivariate analyses were performed using chi-square tests. p values <0.05 were considered statistically significant. Institutional review board deemed that this anonymous voluntary survey met criteria for exemption.

RESULTS

50 respondents met criteria for study inclusion (estimated response rate 42%). Of the respondents, 60% were trainees, 80% practiced in academic institutions and 92% were full-time. 100% intended to breastfeed, of whom 56% met personal breastfeeding goals (12-month median duration). Available lactation facilities included: Dedicated lactation room (38%), private space (58%), hospital grade pump (30%), refrigerator (46%), dedicated PACS (8%). Cited workplace challenges included lack of time (82%), lack of space (34%), and unsupportive work culture (42%). Having adequate time was associated with meeting breastfeeding goals (p = 0.028). No other factors were statistically significant (p > 0.05).

CONCLUSION

Almost half of breastfeeding radiologists (44%) did not meet breastfeeding goals, citing a variety of facility-based and institutional barriers. Among these, having sufficient time to pump/breastfeed was associated with achieving breastfeeding goals. Given the barriers faced by breastfeeding radiologists, there is an opportunity to make structural and cultural changes to provide lactation support at work.

Flexibility in Faculty Work-Life Policies at Medical Schools in the Big Ten Conference: A Ten-Year Follow-up Study

Background: Flexible work-life policies for medical school faculty are necessary to support career progress, advancement, retention, and job satisfaction.

Objective: Our objective was to perform a 10-year follow-up descriptive assessment of the availability of flexible work-life policies for faculty in medical schools in the Big Ten Conference.

Design: In this descriptive study, a modified objective scoring system was used to evaluate the flexibility of faculty work-life policies at 13 medical schools in the Big Ten Conference. Policy information was obtained from institutional websites and verified with the human resources offices. Scores from the 2011 study and 2020 were compared.

Results: Michigan State and Ohio State Universities offered the most flexible policies (score 17.75/22) with the Universities of Maryland and Minnesota following (score 16/22). The largest delta scores, indicating more flexible policies in the past decade, were at University of Minnesota (5.25) and University of Michigan (5). Policies for parental leave and part-time faculty varied widely. Most schools earned an additional point in the newly added category of “flexible scheduling and return-to-work policies.” Nearly every institution reported dedicated lactation spaces and improved childcare options.

Limitations: Limitations included missing policy data and interpretation bias in reviewing the policy websites, unavailable baseline data for schools that joined the Big Ten after the 2011 study, and unavailable baseline data for the additional category of return-to-work policies.

Conclusions: While progress has been made, every institution should challenge themselves to review flexibility in work-life policies for faculty. It is important to advance a healthy competition with the goal to achieve more forward-thinking policies that improve retention, recruitment, and advancement of faculty. Big Ten institutions can continue to advance their policies by providing greater ease of access to options, further expansion of parental leave and childcare support, and offering more flexible policies for part-time faculty.

Low Prevalence of Designated Lactation Spaces at Hospitals and Ambulatory Surgery Centers in Iowa: An Educational Tool for Graduates' Job Selection

Many anesthesiologists and nurse anesthetists want to continue breastfeeding their babies when returning to work from maternity leave. The cornerstone of breast milk supply maintenance is breast milk pumping sessions at regular intervals. These breast milk pumping sessions require time and private space for lactation. We surveyed Iowa hospitals and ambulatory surgery centers and created an educational spreadsheet to guide inquiry and postgraduate job selection of our anesthesiology residents and nurse anesthetist students (eg, when considering future family planning). The survey and spreadsheet showed a low prevalence of dedicated lactation space for anesthesia practitioners near the surgical suites.

Availability of Lactation Accommodation Information for Urology Residency Programs

OBJECTIVE

To assess whether urology residency programs publish information about lactation accommodations online. Although residencies are required to provide lactation accommodations, there is limited data on whether programs disclose this information.

MATERIALS AND METHODS

Webpages of U.S. urology residency programs were assessed for presence of information about lactation. Program characteristics were noted, as were mentions of resident wellness and diversity. Associations between program characteristics and published lactation accommodations were determined by univariate analysis and development of a multivariate logistic regression model.

RESULTS

Of 145 urology residency programs, 72.4% included information about lactation accommodations anywhere on the institution's website There was great variability in ease of accessing information and of quality of information available. Information was most commonly on graduate medical education websites (28.3%) followed by human resources (24.1%), press releases (7.6%), or other sections (11.0%), and least likely to be found on urology residency websites (1.4%). Programs with lactation accommodations anywhere on the institution website were more likely to be larger (p < 0.001), university-based (p < 0.001), and to publish information about resident wellness (p < 0.001), diversity and inclusion (p < 0.001). On multivariate analysis, only university-based setting presence of wellness information were predictors of availability of lactation accommodation information.

CONCLUSION

Lactation accommodation information is usually not available on urology residency websites and most online information is found elsewhere. Predictors of publishing lactation accommodation information were university-based setting and information about resident wellness. Efforts to recruit and retain female urologists should include making this information more easily accessible.

Suggested Work Guidelines, Based on Operating Room Data, for Departments with a Breast Milk Pumping Supervising Anesthesiologist

Objective: Coordinating breast milk pumping sessions is challenging for lactating anesthesiologists who supervise multiple simultaneous anesthetics. We quantify the minimum percentages of adjacent operating rooms (ORs) for which there could reliably (≥95%) be at least 30 minutes during the surgical time when the anesthesiologist covering three anesthetics could have her rooms covered by another anesthesiologist. Methods: The historical cohort study was from a large U.S. teaching hospital. We calculated the 5% lower prediction bounds of surgical times from 3 years of historical data, and then applied them to surgical start times from adjacent ORs during the next 1 year. Results: For >2/3rd of cases, an anesthesiologist supervising three ORs would lack a reliable 30-minute period of overlapping surgical times, and an even smaller chance per case at the ambulatory surgery center, 10% (9-11%). For approximately 42% (41-43%) of sufficiently long individual cases, there was absence of a 30-minute period during which both of the two adjacent ORs' cases were suitable for the anesthesiologist to receive a break (p < 0.0001 compared with one-third). Conclusions: Even when making assumptions that were deliberately unrealistic (e.g., anesthesiologists' responsibilities are only for ongoing OR cases), there is no practical mechanism for an anesthesiologist supervising three ORs to start cases, be relieved for a breast milk pumping session, and then return in time for the end of the anesthetics (e.g., tracheal extubation). Departments with anesthesiologists who are breastfeeding should consider having options for temporary clinical assignments, commensurate with training and experience, that do not require supervising >2 ORs.

Is Lactating in the Emergency Department a Letdown? Exploring Barriers and Supports to Workplace Lactation in Emergency Medicine

STUDY OBJECTIVE

To explore the social and environmental conditions in emergency departments that contribute to perceived barriers and supports for workplace lactation among individuals working in emergency medicine.

METHODS

Constructivist grounded theory was used by our team to understand the social processes and behaviors associated with workplace lactation for health care professionals working in EDs. A total of 24 interviews of individuals in EDs with recent return-to-work experience after childbirth were performed. The interviews yielded 36 unique experiences (from 21 faculty, 12 trainees, and 3 nurses) because some participants had more than 1 child, in which case all lactation experiences were discussed. Interview transcriptions were coded and analyzed iteratively for the development of themes, per constructivist grounded theory.

RESULTS

Using constant comparative inductive methods, we describe 3 pervasive themes as they relate to workplace lactation that emerged from the analysis of interview data: (1) emergency medicine culture, (2) workplace lactation policies, and (3) supports for workplace lactation.

CONCLUSION

Although formalized workplace lactation policies and other identifiable supports for workplace lactation aid individuals desiring to lactate after returning to work in EDs, many individuals still experience cultural barriers to their desired lactation habits. Policies and individual support systems may continue to fall short of meeting the needs of lactating individuals in emergency medicine unless broader cultural change occurs. Our work offers initial recommendations for shifting the landscape of lactation practices in emergency medicine.

Assessing Utilization, Benefits, and Shortfalls of Lactation Resources for Physician Trainees and Other Healthcare Providers

Objective

There is a need to support healthcare providers, including physician-mothers at all training levels, related to breastfeeding and expressing breast milk. This study was designed to understand the attitudes and preferences of lactating employees regarding current lactation resources at an academic medical center.

Methods

Cross-sectional survey. Respondents reported their satisfaction with current lactation resources on scale of 0 [complete dissatisfaction] to 100 [complete satisfaction]. Respondents were asked to identify greatest priorities for improvements to existing lactation spaces.

Results

304 (34.2%) respondents, of whom 69.3% anticipated using a lactation room in the next 5 years. Satisfaction with the current status of lactation rooms was low (mean score 37.8; SD 25.3). Accessible and proximal lactation spaces were highest priorities. More than 50% of respondents indicated daily use of a “nontraditional” lactation space.

Conclusion

This study demonstrates the current state of healthcare providers' lactation-related experiences and highlights priorities for improvement, particularly provision of adequate lactation spaces.

Maternity Experiences and Perceptions of Emergency Medicine Physicians

INTRODUCTION

Postpartum employment has been recognized as a significant obstacle to breastfeeding continuation rates in the general population. Multiple additional factors can influence emergency medicine (EM) physician mothers' ability to continue breastfeeding upon return to work. These include the unpredictable nature of emergency room volumes and acuity, absence of protected lactation time or facilities, and varying levels of support from colleagues. This study investigated a sample of female EM physicians' current perceptions and experiences regarding breastfeeding practices and identified modifiable work-place factors affecting their decision to wean. The authors hypothesized that EM physician mothers would have excellent breastfeeding initiation rates but be largely unable to maintain breastfeeding practices upon returning to work.

METHODS

A 34-item survey questionnaire evaluated demographics, perceptions, and experiences with breastfeeding with a convenience sample of EM attending and resident physicians from two Michigan academic community hospitals.

RESULTS

Thirty-nine surveys were completed, representing a participant response rate of 88.6%. Breastfeeding had been initiated by all respondent mothers, all of whom returned to full-time employment after delivery. Upon return to work, 15 (75%) respondents continued to exclusively breastfeed. The goal of participants was to breastfeed for an average of 7.1 months (± 4.1 months), although the average duration children were exclusively breastfed was 5.8 months (± 4.0 months).

CONCLUSIONS

Based on these results, the reasons for decreased breastfeeding after return to work in an EM residency program setting are multifactorial and include some modifiable interpersonal and institutional influences. These findings support the implementation of work-place strategies and policies to promote successful breastfeeding practices among EM resident and attending physician mothers returning to work.

ABM Clinical Protocol #14: Breastfeeding-Friendly Physician's Office-Optimizing Care for Infants and Children

A central goal of the Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.

Lactation challenges of resident physicians- results of a national survey

Background

There are unique challenges to parenting in residency and there is limited data to guide policy regarding lactation facilities and support for female physicians-in-training. We aimed to assess issues surrounding breast-feeding during graduate medical training for current residents or recent graduates from United States (US) residency programs.

Methods

A national cross-sectional survey was sent to current and recently graduated (2017 and later) female residents in June 2020. This questionnaire was administered using the Qualtrics Survey tool and was open to each participating woman’s organization for 4 weeks. Summary statistics were used to describe characteristics of all respondents and free-text responses were reviewed to identify common themes regarding avenues for improvement.

Results

Three hundred twelve women responded to the survey, representing a 15.6% response rate. The median duration of providing breastmilk was 9 months (IQR 6–12). 21% of residents reported access to usable lactation rooms within their training hospital, in which 12% reported a computer was present. 60% of lactating residents reported not having a place to store breast milk. 73% reported residency limited their ability to lactate, and 37% stopped prior to their desired goal. 40% reported their faculty and/or co-residents made them feel guilty for their decision to breastfeed, and 56% reported their difficulties with breastfeeding during residency impacted their mental health.

Conclusion

Residents who become mothers during training face significant obstacles to meeting their breastfeeding/pumping needs and goals. With these barriers defined, informed policy change can be instituted to improve the lactation experience for physicians-in-training.

Perceptions, Experiences, and Outcomes of Lactation Support in the Workplace: A Systematic Literature Review

BACKGROUND

Despite legislation requiring break time and a private space to express milk, variations exist in accommodations for breastfeeding employees in the United States.

RESEARCH AIMS

We aimed to describe employee and employer perceptions of and experiences with workplace lactation support in the United States and to identify research needed to inform workplace lactation support programs.

METHODS

We searched Academic Search Complete, Business Search Complete, CINAHL, MEDLINE, PubMed, and PsycInfo for peer-reviewed articles published from 2009 to 2019 (n = 1638). We included 27 articles. Studies were categorized into four non-exclusive themes: (a) employee perceptions of and experiences with workplace lactation support; (b) employer reports of workplace lactation support; (c) association between workplace lactation support and business outcomes; and (d) association between workplace lactation support and breastfeeding outcomes.

RESULTS

Analyses of associations between lactation support at work and employee breastfeeding outcomes (n = 14, 52%), and employee perceptions of and experiences with lactation support at work (n = 14, 52%) were most common, followed by employer reports of lactation support (n = 3, 11%) and associations between lactation support at work and job satisfaction (n = 3, 11%). Results indicated that workplace lactation support varied by employer, and that employee perceptions of and experiences with workplace lactation support varied by demographic and employment characteristics. The use of cross-sectional designs, unvalidated instruments, and limited representation from women with low incomes and minorities were common study limitations.

CONCLUSIONS

More research is needed to learn about experiences of employers and low-income and minority women with workplace lactation support and associations with business-relevant outcomes.

Experiences of breast feeding at work for physicians, residents and medical students: a scoping review

OBJECTIVE

To review and summarise the available literature regarding breastfeeding experiences of medical students, residents and physicians.

ELIGIBILITY CRITERIA

Articles of any design, including non-peer reviewed data that examine the experiences of breast feeding of medical students, residents and staff physicians.

INFORMATION SOURCES

Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily, Ovid EMBASE, Scopus and Web of Science.

RISK OF BIAS

All peer-reviewed studies underwent risk-of-bias assessment using relevant tools, depending on the study design.

INCLUDED STUDIES

We included 71 citations; 51 surveys, 3 narrative descriptions, 9 editorials or letters to the editor, and 3 reviews.

SYNTHESIS OF RESULTS

Included articles were heterogeneous with respect to their study design, target population and outcomes reported. Most articles had a high risk of bias. Only five articles reported the impact of an intervention.

DESCRIPTION OF EFFECT

Despite heterogeneity, the majority of articles described important barriers to breast feeding for physicians, residents and medical students. These barriers were similar across studies, and included inadequate and inaccessible space, time constraints and inflexible scheduling, and lack of colleague support. The consequences of these barriers included low milk supply and early discontinuation of breast feeding.

STRENGTHS AND LIMITATIONS OF EVIDENCE

Due to the observed heterogeneity of articles identified in this review, we are unable to assess trends in barriers or duration of breastfeeding over time.

INTERPRETATION

Interventions to overcome systemic and cultural barriers to breast feeding are needed to meet legal obligations of workplaces for physicians and trainees. These interventions should be formally evaluated using implementation science or quality improvement methods.

A Socioecological Approach to Understanding Workplace Lactation Support in the Health Care Setting

Introduction: The percentage of working women with children under the age of 3 has nearly doubled since the 1970s, elevating the importance of understanding and improving workplace lactation support. This study aimed to examine employee perceptions of and experiences with workplace lactation support within a single health care system. We used a socioecological approach and included the views of a broad range of employees with and without lactation experience to capture diverse perspectives at multiple levels. Materials and Methods: Employees were recruited from an integrated health care system in the southeastern United States. Five focus groups were conducted during June to August 2017. Transcripts were analyzed using qualitative content analysis, with key themes organized at four levels of analysis: individual, interpersonal, departmental, and organizational. Results: Thirty-five clinical and nonclinical employees participated. Employees shared varied perspectives on workplace lactation support, which emphasized the: (1) importance of having a lactation policy, (2) critical role of leadership in setting the tone for workplace lactation, and (3) differential experience between clinical and non-clinical lactating employees. Conclusion: Employee experiences with lactation support in the health care setting are influenced by individual, interpersonal, departmental, and organizational factors that must be considered in the design of effective workplace lactation support programs. Policies and programs that align with organizational values and accommodate the needs of employees in varying roles are recommended. By using a socioecological perspective, this study identifies practical strategies for implementing, improving, and sustaining workplace lactation support across multiple levels of a large health care organization.

Parenting While in Training: A Comprehensive Needs Assessment of Residents and Fellows

BACKGROUND

Parenting issues can affect physicians' choice of specialty or subspecialty, as well as their selection of individual training programs, because of the distinctive challenges facing residents and fellows with children. Specific information about how residents perceive these challenges is limited.

OBJECTIVE

We sought to better understand the challenges associated with parenting during residency and fellowship training in order to inform policy and research.

METHODS

In 2017, a voluntary online questionnaire was distributed to all 2214 Partners HealthCare graduate medical education trainees across 285 training programs. The survey queried attitudes of and about trainees with children and assessed needs and experiences related to parental leave, lactation, and childcare. Responses were compared between subgroups, including gender, surgical versus nonsurgical specialty, parental status, and whether the respondent was planning to become a parent.

RESULTS

A total of 578 trainees (26%) responded to the questionnaire. Of these, 195 (34%) became parents during training. An additional 298 (52%) planned to become parents during training. Respondents overwhelmingly agreed that their institution should support trainees with children (95%) and that doing so is important for trainee wellness (98%). However, 25% felt that trainees with children burden trainees without children. Childcare access, affordability, and availability for sufficient hours were identified as key challenges, along with issues related to parental leave, lactation facilities, and effect on peers.

CONCLUSIONS

This survey highlights trainees' perspectives about parenting during their clinical training, signaling parental leave, lactation facilities, and childcare access and affordability as particular challenges and potential targets for future interventions.

Crafting an Evidence-Based, Accreditation Council of Graduate Medical Education-Compliant Lactation Policy for Residents and Fellows

Background: New Accreditation Council of Graduate Medical Education (ACGME) requirements mandate lactation accommodations for resident physicians and fellows. However, to date, few training programs have developed and reported robust lactation support programs or policies. Objective: The authors aimed to develop an evidence-based, ACGME-compliant policy to optimize lactation support for residents and fellows at their institution. Methods: Six Sigma process improvement methodology was utilized to structure this 2018-2019 project. Qualitative methods included stakeholder analysis, feedback sessions, formal needs assessments, and a thorough review of breastfeeding law, societal guidelines, and best practices. Quantitative methods included use of a standardized grading tool for lactation facilities. Quality assurance efforts are ongoing to ensure successful implementation of the developed policy. Results: The authors present a framework for improving lactation support for residents and fellows and share an institutional policy suitable for implementation by other graduate medical education departments. Conclusions: To ensure compliance with ACGME requirements and address breastfeeding challenges faced by medical trainees, it is crucial that U.S. residencies and fellowships implement lactation policies to support trainees. The authors welcome the modification and utilization of the evidence-based, ACGME-compliant policy reported herein.

The Birth of a Return to work Policy for New Resident Parents in Emergency Medicine

OBJECTIVE

With the rising number of female physicians, there will be more children than ever born in residency, and the current system is inadequate to handle this increase in new resident parents. Residency is stressful and rigorous in isolation, let alone when pregnant or with a new child. Policies that ease these stressful transitions are generally either insufficient or do not exist. Therefore, we created a comprehensive return-to-work policy for resident parents and piloted its implementation. Our policy aims to: 1) establish a clear, shared understanding of the regulatory and training requirements as they pertain to parental leave; 2) facilitate a smooth transition for new parents returning to work; and 3) summarize the local and institutional resources available for both males and females during residency training.

METHOD

In Fall 2017, a task force was convened to draft a return-to-work policy for new resident parents. The task force included nine key stakeholders (i.e., residents, faculty, and administration) at our institution and was made up of three graduate medical education (GME) program directors, a vice chair of education, a designated institutional official (DIO), a chief resident, and three members of our academic department's faculty affairs committee. The task force was selected because of individual expertise in gender equity issues, mentorship of resident parents, GME, and departmental administration.

RESULTS

After development, the policy was piloted from November 2017 to June 2018. Our pilot implementation period included seven new resident parents. All of these residents received schedules that met the return-to-work scheduling terms of our return-to-work policy including no overnight shifts, no sick call, and no more than three shifts in a row. Of equal importance, throughout our pilot, the emergency department schedules at all of our clinical sites remained fully staffed and our sick call pool was unaffected.

CONCLUSION

Our return-to-work policy for new resident parents provides a comprehensive guide to training requirements and family leave policies, an overview of available resources, and a scheduling framework that makes for a smooth transition back to clinical duties.

Maternity Leave and Its Impact on Breastfeeding: A Review of the Literature

BACKGROUND

Breastfeeding is known to be the best source of nutrition for infants. The World Health Organization recommends to exclusively breastfeed up to the sixth month of life and to breastfeed with complementary foods until the age of 2. It is reported that maternity leave (ML) is one of the most important interventions for an extended breastfeeding duration. The aim of this review is to synthesize the available data worldwide on the association of ML and breastfeeding duration. We also intend to provide an overview of whether this association is differential by socioeconomic status.

MATERIALS AND METHODS

Relevant primary studies relating ML and breastfeeding were included by searching several databases, including PubMed, SCielo, Health Systems Evidence, Health Evidence, Cochrane Reviews, and Epistemonikos. Articles were included up to May 2018.

RESULTS

A total of 239 relevant articles were identified, of them 21 were included in the review based on exposure, outcome, and study design. These studies reported that an extended ML might be related to breastfeeding duration. In addition, studies reporting data on work type, race, and education showed that black women, women in less privileged position, and women with less education have less breastfeeding duration.

CONCLUSIONS

This review showed a positive relationship between ML length and breastfeeding duration. These results have a homogeneous trend; however, this was different when studies reported results on ML and breastfeeding stratified by socioeconomic status. Public health policies should ensure that all women, especially the most vulnerable, have equal access to the benefits that ML provides.