"Frustrated," "depressed," and "devastated" pediatric trainees: US academic medical centers fail to provide adequate workplace breastfeeding support

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.

Latching Medical Students onto a Virtual Breastfeeding Elective During the COVID-19 Pandemic

Objectives: To describe the implementation of a successful two-week virtual breastfeeding elective for medical students during the COVID-19 pandemic and characterize student demographics, objective knowledge, and perspectives on breastfeeding before and after the elective. Study Design: We adapted the Santa Rosa Kaiser Permanente Family Medicine breastfeeding residency curriculum to create a two-week virtual medical student elective using Kern's six steps of curriculum development and a competency-based education framework. Educational components included self-paced modules, shadowing experiences, and group didactics. Objective knowledge was assessed with multiple-choice tests before and after the elective compared using a paired t-test. Reflective writing pieces were qualitatively analyzed using the six phases of thematic analysis developed by Braun and Clarke. Results: From 2020 to 2023, 40 medical students completed the elective. Breastfeeding knowledge increased significantly from the pre-test 72% (95% CI: 52-92%) to post-test 91% (95% CI: 81-100%) (p < 0.001). Over 90% of students felt that learning objectives were met well or very well and agreed or strongly agreed that the elective increased their knowledge and confidence in providing anticipatory guidance to breastfeeding parents. Similar themes were shared across students' reflective writing pieces, with nearly 30% (n = 23) of the student essays addressing socio-cultural and racial differences in beliefs surrounding breastfeeding. Conclusion: A virtual breastfeeding curriculum for medical students is well-received by stakeholders (patients, lactation consultants, students, etc.) and improves breastfeeding knowledge and confidence. A virtual elective is an innovative and effective way to deliver breastfeeding education and can be used even when institutional breastfeeding or lactation support is unavailable.

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.

Successful return to work in anaesthesia after maternity leave: a qualitative study

Returning to work after maternity leave poses significant challenges, with potential long-term implications including decreased engagement or attrition of clinicians. Many quantitative studies have identified challenges and supports for women during pregnancy, maternity leave and re-entry to clinical practice. This qualitative study explored the experiences of anaesthetists returning to clinical work after maternity leave, to identify influential factors with the aim of providing a framework to assist planning re-entry. We conducted semi-structured interviews with 15 anaesthetists. Attendees of a re-entry programme were invited to participate, with purposive sampling and snowball recruitment to provide diversity of location and training stage, until data saturation was reached at 13 interviews. Five themes were identified: leave duration; planning re-entry; workplace culture; career impact and emotional impact. Leave duration was influenced by concerns about deskilling, but shorter periods of leave had logistical challenges, including fatigue. Most participants started planning to return to work with few or no formal processes in the workplace. Workplace culture, including support for breastfeeding, was identified as valuable, but variable. Participants also experienced negative attitudes on re-entry, including difficulty accessing permanent work, with potential career impacts. Many participants identified changes to professional and personal identity influencing the experience with emotional sequelae. This research describes factors which may be considered to assist clinicians returning to work after maternity leave and identifies challenges, including negative attitudes, which may pose significant barriers to women practising in anaesthesia and may contribute to lack of female leadership in some workplaces.

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.

Breastfeeding environment and experiences at the workplace among health workers in the Upper East Region of Ghana

BACKGROUND

Employed mothers have lower rates of breastfeeding, including health workers who are supposed to be advocates for breastfeeding. These working mothers need a supportive workplace environment to breastfeed, yet Ghana's breastfeeding policy neither mentions the workplace breastfeeding environment nor offers any information on it.

METHODS

A convergent parallel mixed-methods design was used in this study to determine: facilities with a complete breastfeeding support environment (BFSE); breastfeeding challenges experienced; coping strategies and motivators for breastfeeding among health workers in the Upper East Region of Ghana; and Management's awareness of the need for an institutional breastfeeding support policy. Quantitative and qualitative data were analyzed using descriptive statistics and thematic analysis respectively. The research was conducted from January to April 2020.

RESULTS

All facilities (39) had incomplete BFSE and management representatives of health facilities (39) did not have and were not aware that their respective facilities needed to have a specific workplace breastfeeding policy that fed into the national policy agenda. Breastfeeding challenges at workplaces included: lack of private space for breastfeeding; inadequate support from co-workers and management; emotional stress; and inadequate breastfeeding breaks and work options. Women adapted to these challenges by employing coping strategies such as: bringing children to work with / without caretakers; leaving children at home; seeking support from co-workers and family members; feeding children with supplementary foods; adding annual leave to maternity leave; breastfeeding in cars / offices; and sending children to daycare. Interestingly, the women were still motivated to breastfeed. Health benefits of breastmilk, the convenience and readily available nature of breastmilk, moral obligation to breastfeed, and cheap cost of breastmilk emerged as key motivators to breastfeed.

CONCLUSION

Our findings suggest that health workers have poor BFSE and are faced with numerous breastfeeding challenges. There is a need for programs that improve BFSE in health facilities.

Supporting Breastfeeding Physicians Across the Educational and Professional Continuum: A Call to Action

The benefits of breastmilk and lactation are well established for both infants and women. National organizations recommend exclusively breastfeeding for the first 6 months of life and continued breastfeeding for the first 1-2 years of life. For physicians, childbearing years often coincide with key periods of training and their early career. Physician mothers have high rates of initiating breastfeeding but low success in maintaining breastfeeding. Breastfeeding discontinuation among physicians is a well-described, multifactorial issue that has persisted for decades. Reasons for discontinuation include inadequate access to pumping rooms, insufficient workplace and coworker support, and constrained schedules. Pumping is viewed as a burden to teammates and superiors, and physicians are often required to make up time spent pumping. Vague or absent policies to support breastfeeding by accreditation organizations and institutions create workplace conflict and impose additional stress on breastfeeding physicians, who devote significant time, energy, and mental reserves navigating clinical responsibilities, workplace relationships, and licensing requirements to pump. The authors propose several recommendations to improve the environment, support, and resources for breastfeeding physicians with a focus on what individuals, institutions, and professional organizations can do. Creating lactation policies that allow breastfeeding physicians equitable participation in the workplace is a matter of reproductive justice. Improving the collective awareness and support for breastfeeding trainees and physicians is a critical step in recruiting, retaining, and supporting women in medicine.

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.

Parent-in-training: Resident and fellow experiences from pregnancy to parenthood

BACKGROUND

Residents and fellows with children face distinct challenges; however, knowledge of factors associated with increased parental stress is limited.

OBJECTIVE

This study aimed to investigate experiences and concerns of physician trainees and identify factors associated with higher parental stress.

METHODS

An anonymous survey was distributed to all resident and fellow trainees in June 2021 to assess experiences regarding parental leave, breastfeeding, and childcare. We used the Parental Stress Scale (PSS) to identify the factors associated with stress and analyzed the results using descriptive statistics, linear regression, and thematic analysis.

RESULTS

Of 1719 trainees, 509 participated (62% women, 30% response rate); half were parents. One-third of the respondents (152/470) said that childcare costs affected the number of children they plan to have; One-third of respondents (152/470) said that childcare costs affected the number of children they plan to have; 45% (210/470) said childcare costs affected when they plan to have children. Among parents, the mean PSS score was 44.3 ± 12.3, with no significant gender differences. More women identified as primary or coprimary caregivers (97% [113/117] vs. 79% [60/76], p < .001) and anticipated training extensions due to parental leave (36% vs. 13% men, p = .009). Breastfeeding was associated with significantly higher PSS scores (p = .017). Twenty-four percent of breastfeeding parents (22/93) felt that their program/institution did not support their breastfeeding goals; lack of perceived support was associated with significantly higher PSS scores (63.6 ± 13.1 vs. 38.6 ± 8.7, p < .001). Trainees experiencing unreliable childcare had significantly higher PSS scores (p = .005). Forty percent (64/159) changed their career plans after becoming parents.

CONCLUSIONS

Physician trainee parents experience high stress, with women bearing disproportionate burdens in the domains of parental leave and breastfeeding. These results should inform policies promoting trainee wellness and gender equity.

Understanding the challenges related to breastfeeding education and barriers to curricular change: a systems perspective for transforming health professions education

OBJECTIVES

A majority of women and families wish that their babies be breastfed. However, too many still receive insufficient or inappropriate initial care from health professionals (HPs) who have limited breastfeeding (BF) competencies. We investigated barriers and potential solutions to improve the undergraduate training programs for various HPs.

METHODS

Focus groups were carried out in three universities in Quebec and one in Ontario (Canada), with 30 faculty and program directors from medicine, midwifery, nursing, nutrition, and pharmacy. Discussions were subjected to thematic content analysis, before being validated in a strategic planning workshop with 48 participants from the same disciplines, plus dentistry and chiropractic.

FINDINGS

Substantive improvements of undergraduate training programs for BF could be obtained by addressing challenges related to the insufficient, or lack of, (i) interactions among various HPs, (ii) opportunities for practical learning, (iii) specific standards to guide course content, (iv) real-life experience with counselling, and (v) understanding of the influence of attitudes on professional practice. Several potential solutions were proposed and validated. The re-interpretation of the results in light of various literature led to an emerging framework that takes a systems perspective for enhancing the education of HPs on BF.

CONCLUSIONS

To improve the education of HPs so as to enable them to provide relevant support for future mothers, mothers and their families, solutions need to be carried out to address challenges in the health system, the education system as well as regarding the curricular change process.

Breastfeeding Among Pediatric Emergency Physicians: Rates, Barriers, and Support

OBJECTIVES

Physician mothers are at risk for early cessation of breastfeeding, in part because of challenges associated with returning to work. Given the inherent unpredictability of emergency medicine practice, we hypothesized that pediatric emergency medicine (PEM) physicians would face unique challenges in continuing breastfeeding while working in their field. The aims of this study were to determine the 6-month breastfeeding rates of PEM physicians, gain insight into their experiences expressing breast milk while working in pediatric emergency departments, and determine factors that support or discourage successful breastfeeding.

METHODS

This study was a cross-sectional survey of members of the American Academy of Pediatrics Section on Emergency Medicine via its quarterly membership survey program. Separate survey pathways were developed for respondents who had ever breastfed and those who had not.

RESULTS

One hundred ninety-three responded; 91 had breastfed, and 102 had not. Of those who breastfed, 90% did so for 6 months or longer. Mean (SD) duration was 12.5 (7.1) months (range, 2-48 months). Of those who expressed milk at work, only 7.6% felt they "always" had sufficient time to pump; 32% felt they "always" had what they considered to be an appropriate location to pump. Breastfeeding duration rate of at least 6 months was higher for those (66%) who "sometimes" to "always" had access to what they felt were appropriate locations to pump than for those (34%) who "never" or "occasionally" did (98 vs 85%, P = 0.048). Eighty-six percent of respondents who had never breastfed reported being "very supportive" of expressing milk at work.

CONCLUSIONS

Breastfeeding PEM physicians have high 6-month breastfeeding rates, and many express milk at work. Although colleagues report being supportive, barriers of perceived lack of sufficient time to pump and appropriate pumping locations remain.

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.

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.

Workplace Leave and Breastfeeding Duration Among Postpartum Women, 2016-2018

Objectives. To examine associations of workplace leave length with breastfeeding initiation and continuation at 1, 2, and 3 months. Methods. We analyzed 2016 to 2018 data for 10 sites in the United States from the Pregnancy Risk Assessment Monitoring System, a site-specific, population-based surveillance system that samples women with a recent live birth 2 to 6 months after birth. Using multivariable logistic regression, we examined associations of leave length (< 3 vs ≥ 3 months) with breastfeeding outcomes. Results. Among 12 301 postpartum women who planned to or had returned to the job they had during pregnancy, 42.1% reported taking unpaid leave, 37.5% reported paid leave, 18.2% reported both unpaid and paid leave, and 2.2% reported no leave. Approximately two thirds (66.2%) of women reported taking less than 3 months of leave. Although 91.2% of women initiated breastfeeding, 81.2%, 72.1%, and 65.3% of women continued breastfeeding at 1, 2, and 3 months, respectively. Shorter leave length (< 3 months), whether paid or unpaid, was associated with lower prevalence of breastfeeding at 2 and 3 months compared with 3 or more months of leave. Conclusions. Women with less than 3 months of leave reported shorter breastfeeding duration than did women with 3 or more months of leave. (Am J Public Health. 2021;111(11):2036-2045. https://doi.org/10.2105/AJPH.2021.306484).

Breastfeeding frequency of primary healthcare professionals and effective factors

BACKGROUND

To determine the frequency of breastfeeding of mothers working in primary care, the differences between different employment groups, and the effective factors.

METHODS

This descriptive research study was conducted with a self-report online survey design. The snowball sampling method was used for the sample selection, and 151 family physicians and 126 family health professionals were included in the study during the research period (June 2019-December 2019). A 35-item survey was used to collect data. The response rate was 44.9% (49.5% family physicians/40.3% family health professionals).

RESULTS

The mean duration of exclusive breastfeeding was 3.9 ± 2.0 months, and the mean duration of total breastfeeding was 16.7 ± 8.5 months. There was no significant difference between the family physicians and family health professionals in terms of exclusive breastfeeding (P = .580) and total breastfeeding (P = .325) durations. The most common reasons for weaning were reduced milk supply (25.6%) and not being able to use breastfeeding leave (23.1%) due to problems at work. Of the sample, 41.3% had problems with their coworkers and 41.9% had problems related to patient care when taking breastfeeding leave. Working in a baby-friendly centre (P = .01), prolonged exclusive breastfeeding (P < .001), and increased hours of breastfeeding leave taken (P = .001) had a positive effect on breastfeeding for ≥24 months while experiencing problems with coworkers in taking breastfeeding leave (P = .023) had a negative effect on this variable.

CONCLUSIONS

All of the factors that were determined to affect the continuation of breastfeeding for ≥24 months are modifiable. It is very important for relevant authorities to undertake necessary action to improve the conditions of working mothers based on these results. Health professional that can maintain the balance between family and work will work more efficiently.

Pediatric Trainees as Parents: Perspectives on Parenthood From Pediatric Resident Parents

OBJECTIVES

Prior work across medical and surgical specialties shows that parenthood during residency training is associated with challenges including limited parental leave, lack of accommodations for breastfeeding, and concerns about career impact. Less is known about the experience of parenthood during pediatric residency training. The objective of this study was to identify themes related to the experience of parenthood during pediatric residency.

METHODS

In this qualitative study using thematic analysis, we performed semistructured interviews with participants who were currently in pediatric residency or had graduated in the previous 3 years and were parents during residency. Participants were recruited by e-mail. Data were collected and analyzed iteratively until thematic saturation was achieved. Two independent reviewers coded each transcript. Codes were grouped into categories and then into dominant themes.

RESULTS

Thirty-one residents were interviewed from 13 pediatric residency programs. Four major themes regarding the experience of parenthood during pediatric residency were defined by the data: 1) the struggles of parenthood and residency exacerbate each other; 2) institutional modifiers strongly influence the experiences of resident parents; 3) resident parents develop skills and perspectives that enhance their pediatric training; and 4) although levels of support for pediatric resident parents vary, the culture of pediatrics positively influences the experience of parenthood in residency.

CONCLUSIONS

There are numerous challenges navigating parenthood and residency, but institutional policies and culture can modify the experience. Importantly, the educational value of parenthood to pediatric training was immense. Our findings may be used to design interventions to support parenting during residency.

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.

Experiences of breastfeeding among women residents in Alberta: a cross-sectional survey

OBJECTIVES

Breastfeeding at work is recommended by pediatric society guidelines and is protected by employment and human rights law in many countries. Despite this, previous studies have found that residents report important structural barriers to breastfeeding at work.

METHOD

We administered a cross-sectional, electronic, multicenter survey of all women residents in Alberta who were parents in 2017. The study aimed to characterize respondents' experiences of breastfeeding, including duration, goals, barriers, and support from colleagues.

RESULTS

There were 110 respondents, of whom 53 individuals had breastfed 83 children during residency. While nearly all felt that breastfeeding was important to them, only 69.2% reported meeting their breastfeeding duration goal. Surgical residents were less likely to meet their breastfeeding duration goal than residents in other disciplines (40.0% (n = 6/15) compared to 80.0% of non-surgical (n = 28/35) and 80.0% of family medicine residents (n = 12/15)). Residents reported stopping breastfeeding earlier than they desired due to lack of adequate space (48.7%, n = 19) and lack of time (57.1%, n = 24). Twelve participants (10.9%) reported hearing a derogatory comment from a staff physician about their breastfeeding.

CONCLUSIONS

Women residents face barriers to breastfeeding at work which require systems-level intervention. Residents from surgical programs may be the most vulnerable to these barriers. Program directors, residency wellness committees, and hospital administrators should prioritize addressing these barriers for women residents returning to work after maternity leave. Examples of interventions that may address these barriers include policies, designation of lactation spaces, and flexible return-to-work schedules.

Landscape Analysis of Breastfeeding-Related Physician Education in the United States

Background: Breastfeeding is the preferred form of infant nutrition supporting optimal health of mothers and children. Research shows that medical training is deficient in preparing physicians to develop the knowledge base, clinical management skills, and attitudes to provide optimal support for breastfeeding families. We developed this project to assess the current gaps in breastfeeding education during medical training for physicians and to inform the plan to address those gaps. Materials and Methods: We conducted key informant interviews with nine professionals representing medical education, physician professional membership organizations, and ancillary stakeholders with an interest in improving physician education and training with respect to breastfeeding. Using those results, we developed and conducted a survey of physicians to identify training in breastfeeding received during medical school, residency/fellowship, and continuing medical education; confidence in managing breastfeeding; and attitudes about breastfeeding training. A total of 816 respondents completed the survey from the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, and the American Academy of Family Physicians. Results: Gaps exist in the training of physicians in terms of knowledge base, and clinical skills in breastfeeding support as highlighted through detailed key informant interviews and physician surveys. Physicians surveyed in the disciplines of pediatrics, obstetrics and gynecology, and family medicine indicated a desire to have more breastfeeding education integrated into their training, especially addressing clinical evaluation and management of breastfeeding problems. Conclusion: The landscape analysis demonstrates that medical education in breastfeeding remains inadequate despite previous efforts to address the gaps and that physicians desire more training in breastfeeding, especially clinical skills training, to improve provider confidence and competence. The analysis provides the foundation for further efforts to develop a comprehensive plan to enhance physician education in breastfeeding.

Too Old to Be Breastfed? Examination of Pre-Healthcare Professionals' Beliefs About, and Emotional and Behavioral Responses toward Extended Breastfeeding

While breastfeeding seems to be widely accepted in the United States, extended breastfeeding (defined as breastfeeding beyond 12 months of age) tends to be stigmatized. Healthcare professionals are assumed to play a significant role in supporting women who desire to practice extended breastfeeding; however, how healthcare professionals react to extended breastfeeding has not been well understood. This research surveyed 116 healthcare students, who majored in nursing and human medicine, and examined their perceived advantages and disadvantages, emotional responses to, and advice that they would provide to future mothers regarding extended breastfeeding. The results indicated that students responded predominantly with negative emotions and neutral responses to extended breastfeeding, with a small number of participants responding with positive emotions. Many participants believed that it would bring benefits to the child and that it would be burdensome to the mother. Participants displayed a variety of behavioral responses when asked about advice that they would provide to future mothers with whom they will interact in a clinical setting. Practical implications are discussed.

Physician Mothers and Breastfeeding: A Cross-Sectional Survey

Objectives: To explore infant-feeding intentions and behavior of physician mothers as well as their breastfeeding enablers and obstacles. Study Design: A cross-sectional online survey was conducted among female physicians with at least one biological child recruited through the Academy of Breastfeeding Medicine. The main outcomes were duration of exclusive breastfeeding (EBF) and duration of any breastfeeding (BFD). We determined predictors of EBF and BFD. Results: The 570 participants reported intention to breastfeed at least 12 months in 78.1% of cases. Breastfeeding rates were 97.8%, 85.5%, and 55.4% at birth, 6, and 12 months. EBF rates were 88.5%, 76.3%, and 40.9% at birth, 3, and 6 months. Younger participant age, breastfeeding discontinuation not due to work-related demands, and heightened maternal satisfaction with BFD were associated with longer EBF and BFD. EBF at birth, less maternal stress, availability of time to express milk, and collegial support were associated with longer EBF. Longer maternal BFD goal, longer maternity leave, existence of laws or regulations to support breastfeeding among working mothers, later child order, and lower level of maternal depression were associated with longer BFD. Conclusions: Maternal infant-feeding intentions and work-related factors both play important roles in physician mothers' infant-feeding behavior. Longer maternity leave, regulations to support breastfeeding among working mothers, and workplace support might significantly improve physician mothers' BFD.

Stillen und Stillberatung

Muttermilch (Stillen) stellt die Norm der Säuglingsernährung dar. Stillen ist die Standardernährungsform für den ersten Lebensabschnitt eines Menschen. In der Folge wird bei der Einführung von Beikost aus ausschließlichem Stillen weiterbegleitendes Stillen – bis zum vollständigen Übergang zur Familienkost. Die Zusammensetzung der Muttermilch und die hormonelle Steuerung der Milchbildung sind optimal auf das Kind abgestimmt. Stillen ist jedoch kein instinktives, sondern ein sozial erlerntes Verhalten und bedarf von Anbeginn an begleitender Information und Beratung der Mutter und der Familien. Medizinisches Fachpersonal wird als kompetent in Ernährungsfragen erachtet und sollte daher über ausreichende wissenschaftlich fundierte Kenntnis bezüglich der physiologischen Vorgänge im Zusammenhang mit Stillen sowie der Kurz- und Langzeitauswirkungen von Stillen auf die Gesundheit von Mutter und Kind verfügen. Ebenso sollten die Risiken von Formulaernährung (Säuglingsfertignahrung auf Kuhmilchbasis) für die Entwicklung und verschiedene Erkrankungen bekannt sein.

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.

[UNSUCCESSFUL BREASTFEEDING FROM THE PERSPECTIVE OF HEALTHCARE PRACTITIONERS: CASE STUDY, REGION IX, CHILE]

OBJECTIVE

To explore unsuccessful cases of breast-feeding from the perspective of healthcare professionals working with mothers and babies in the breastfeeding process.

METHODS

Qualitative study with an exploratory-descriptive scope, approached from the perspective of grounded theory. Healthcare professionals involved in breastfeeding care in Region IX in Chile were asked to analyze their experiences with unsuccessful breastfeeding. The data were digitized and grouped by questions in order to arrive at codes and categories typically used in manifest content analysis. Group analysis with anonymity preservation was used.

RESULTS

Three categories were identified, starting with adverse factors that acted as barriers to successful breastfeeding, such as undesired pregnancy, mother's age and occupation, changes in breastfeeding routines, ineffectual support networks, physical conditions and problems with breastfeeding techniques. On the other hand, absence of protective factors such as comprehensive healthcare, positive reinforcement and job flexibility. The third category had to do with the emotional impact on the mother caused by the inability to breastfeed, which could be overcome by means of family containment and/ or psychological support to help mothers accept unsuccessful breastfeeding.

CONCLUSIONS

Healthcare professionals identified factors hindering breastfeeding, some of them amenable to intervention. Emphasis is made on the importance of providing assistance and information, building empathy and giving support to the mother in order to strengthen her confidence in her ability to breastfeed the baby.

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.

Maternity Leave in Residency: A Multicenter Study of Determinants and Wellness Outcomes

PURPOSE

To characterize determinants of resident maternity leave and the effect of length of leave on maternal well-being.

METHOD

In 2017, the authors sent a voluntary, anonymous survey to female residents at 78 programs, in 25 unique specialties, at 6 institutions. Survey items included personal, partner, and child demographics, and logistics of leave, including whether leave was paid or vacation or sick leave was used. Outcomes were maternity leave length; duration of breastfeeding; burnout and postpartum depression screens; perceptions of support; and satisfaction with length of leave, breastfeeding, and childbearing during residency.

RESULTS

Fifty-two percent (804/1,537) of residents responded. Among 16% (126) of respondents who were mothers, 50% (63) had their first child during residency. Seventy-seven maternity leaves were reported (range, 2-40 weeks), with most taking 6 weeks (32% of leaves; 25) and including vacation (81%; 62) or sick leave (64%; 49). Length of leave was associated with institution, use of sick leave or vacation, and amount of paid leave. The most frequently self-reported determinant of leave was the desire not to extend residency training (27%; 59). Training was not extended for 53% (41) of mothers; 9% (7) were unsure. Longer breastfeeding duration and perceptions of logistical support from program administration were associated with longer maternity leaves. Burnout affected approximately 50% (38) of mothers regardless of leave length.

CONCLUSIONS

This study illustrates variability in administration of resident maternity leaves. Targets for intervention include policy clarification, improving program support, and consideration of parent wellness upon return to work.

Parenthood During Graduate Medical Education: A Scoping Review

PURPOSE

To conduct a scoping review of the literature on parenthood during graduate medical education (GME) and to develop a conceptual framework to inform policy and guide research.

METHOD

The authors searched PubMed and Embase for articles published from January 1993 through August 7, 2017, using a query framework that combined the concepts of "person" (e.g., "trainee") and "parenthood" (e.g., "breastfeeding"). They included studies describing parenthood or pregnancy of trainees in U.S. GME training programs. Two authors independently screened citations and abstracts and performed kappa coefficient tests to evaluate interreviewer reliability. Two authors performed a full-text review of and extracted data from each included article, and 4 authors coded data for all articles. The authors used descriptive statistics and qualitative synthesis to analyze data.

RESULTS

Ninety articles met inclusion criteria, and nearly half (43/90; 48%) were published between 2010 and 2017. The authors developed 6 themes that surround resident parenthood: well-being, maternal health, others' perceptions, relationships, program preparation, and policy. They mapped these themes by relationship of stakeholders (e.g., infant and family, institutions) to the resident-parent to create a conceptual framework describing parenthood during GME.

CONCLUSIONS

The findings from this scoping review have implications for policy and research. Those authoring parental leave policies could collaborate with national board leaders to develop consistent standards and include nontraditional families. Gaps in the literature include the effect of resident parenthood on patient care, postpartum health, and policy execution. Research in these areas would advance the literature on parenthood during residency.

Family Leave and Return-to-Work Experiences of Physician Mothers

IMPORTANCE

With the substantial increase in the proportion of women graduating from medical school, factors surrounding family leave require careful attention. Although many circumstances and experiences are unique to the training setting and specialty, a nationwide representation of physician mothers across all disciplines and all levels of training may reveal common themes and experiences among them, enable comparison across training setting and subspecialties, and identify best practices for supporting physician mothers throughout their careers.

OBJECTIVE

To characterize family leave and return-to-work experiences of physician mothers across subspecialties.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional US nationwide survey study evaluating the experiences of 844 physician mothers was administered electronically via REDCap from September 2 to December 20, 2018.

MAIN OUTCOMES AND MEASURES

A survey was developed using a modified Delphi process with a panel of experts to characterize physician mothers' family leave and return-to-work experiences. The survey covered both negative and positive experiences of physician mothers for each child they conceived or adopted after medical school to identify areas for change and strategies for successfully supporting physician parents.

RESULTS

Of 1465 potentially eligible survey respondents, 844 (57.6%) were verified as unique respondents with complete surveys. Their mean (SD) age was 35.8 (5.2) years (range, 27-67 years), with most women (826 [97.9%]) currently practicing and 138 women (16.4%) currently in a residency program. Participants were included from 19 subspecialty groups. Of the women surveyed, 619 (73.3%) felt that leave time was insufficient. The majority (751 [89.0%]) would have preferred 11 weeks to 6 months of leave vs the 5 to 12 weeks (often not paid) most commonly available. The most frequently reported negative experiences when returning to work were associated with lack of facilities for breast pumping (range, 12 of 78 [15.4%] for the third child to 272 of 844 [32.2%] for the first child) and time for breast pumping (range, 27 of 78 [34.6%] for the third child to 407 of 844 [48.2%] for the first child), difficulty obtaining childcare (eg, for the first child, 298 of 844 [35.3%]), and discrimination (eg, for the first child, 152 of 844 [18.0%]). The most common positive experience was emotional support (eg, for the first child, 504 of 844 [59.7%]), primarily from colleagues.

CONCLUSIONS AND RELEVANCE

The present study, capturing one of the largest and most heterogeneous samples of physician mothers, showed that a substantial number of women physicians working in a variety of specialties at all levels of training across the United States needed and wanted more support for maternity leave and return to work. Support at the institutional level, such as paid leave, adequate breast pumping time without penalty, on-site childcare, and schedule flexibility, would likely provide the greatest direct assistance to help physician mothers thrive in their careers.

Differing Experiences with Breastfeeding in Residency Between Mothers and Coresidents

Background: Returning to work and lack of support for expressing breast milk (pumping) at work is often cited as a reason that mothers discontinue breastfeeding, particularly among female physicians. It is unclear how these perceived difficulties affect resident mothers and how resident teams perceive coresidents who choose to pump at work. The goal of this study was to identify differences in perception of resident mothers and their coresidents about breastfeeding residents pumping. Materials and Methods: An online survey in 2017 was sent to 413 residents in Pediatrics, Internal Medicine, Family Medicine, and Anesthesia at the University of Michigan Health System. Results: A total of 82 residents completed the survey (20% response rate). Resident mothers (15% of respondents self-identified as a mother) were asked specific questions regarding their experiences with breastfeeding. Almost all mothers (92%) encountered difficulty in breastfeeding after returning to work. The majority of mothers reported that their mood was affected by these difficulties (85%). The most common challenge that breastfeeding residents encountered was not enough time to pump. The majority of all residents surveyed (74%) have worked with a breastfeeding resident. Forty percent of breastfeeding residents felt that their pumping adversely affected the team, whereas only 10% of coresidents felt the same. Conclusions: Breastfeeding residents encountered significant difficulties that affected their well-being when breastfeeding while returning to work. They also felt that their pumping can be detrimental to their job. However, their coresidents felt that pumping had no major setbacks to team efficiency or patient care and did not create additional work.

An Exploration of Lactation Facilities and Planning in U.S. Higher Education Campuses

BACKGROUND

Women in academia face challenges in continuing breastfeeding. Higher education campuses are investing in lactation support, but little is known about their approaches. This study explores the planning and design of lactation spaces on college and university campuses from the perspectives of campus planners and facility professionals, administrators, and other decision-makers.

MATERIALS AND METHODS

We conducted an online survey with a convenience sample of members of the Society for College and University Planning (SCUP). Representatives from each U.S. member campus were invited to participate in an online survey.

RESULTS

One hundred five individuals responded, representing their institutions; 94% reported at least one dedicated lactation space (range 0-50). Sixty-eight percent reported having a policy for creating/identifying lactation spaces; 28% reported that the lactation space was included in campus construction standards. Over 80% of spaces were structurally enclosed, lockable, Americans with Disabilities Act (ADA) compliant, and had open electrical outlets and in-room light control. Campus/facility planning was involved in lactation space planning at 77% of institutions and in funding for creation and maintenance at 59%.

CONCLUSIONS

Many campuses are building lactation infrastructure, but there is considerable variability in approaches and accommodations for lactation at higher education institutions. While local conditions, constraints, and demands will inform program development, decision-makers can leverage campus resources, recommendations, and design best practices to improve lactation experiences of women.

Impact of Training Specialty on Breastfeeding Among Resident Physicians: A National Survey

OBJECTIVES

The United States has seen an increasing number of child-bearing women in medical training. We aimed to compare the prevalence of exclusive breastfeeding across varied specialties, whose trainees may face different obstacles to breastfeeding.

MATERIALS AND METHODS

An online survey querying the duration and barriers to breastfeeding was sent to Accreditation Council for Graduate Medical Education (ACGME) and American Osteopathic Association (AOA) programs. Female residents with at least one living child born during residency were eligible. We compared the prevalence of exclusive breastfeeding for 6 months between Obstetrics and Gynecology (OBGYN), nonsurgical, and non-OBGYN surgical specialties. A multiple regression model correcting for ethnicity, years lived in the United States, medical degree, year of residency at childbearing, geographical location, and clinical hours was performed.

RESULTS

There were 708 completed surveys, including 561 nonsurgical, 73 OBGYN, and 74 non-OBGYN surgical residents. More OBGYN residents reported exclusive breastfeeding at 6 months (43/73, 59%) than nonsurgical (217/561, 39%) and non-OBGYN surgical residents (30/74, 41%) (p < 0.01). After adjusting for confounders, OBGYN trainees were twice as likely to breastfeed (adjusted odds ratio [AOR] = 2.18, 95% confidence interval [CI] 1.28-3.72) with no difference between non-OBGYN surgical and nonsurgical residents (AOR = 1.24, 95% CI 0.70-2.19). Less OBGYN residents reported the lack of breastfeeding facilities at work (2.7% versus 17.6%, p < 0.01) and inadequate leave (4.1% versus 17.6%, p = 0.01) than non-OBGYN surgical residents.

CONCLUSIONS

In this national survey of trainees in accredited programs, OBGYN residents were twice as likely to breastfeed and fewer OBGYN residents cited barriers to breastfeeding compared to other residents.

Impact of Key Workplace Breastfeeding Support Characteristics on Job Satisfaction, Breastfeeding Duration, and Exclusive Breastfeeding Among Health Care Employees

Background: Although national breastfeeding rates have improved across recent decades, women continue to face barriers to achieving recommended breastfeeding targets. Returning to work presents a unique set of challenges for breastfeeding continuation, even in health care settings tasked with promoting breastfeeding among patients. This study examined the association between key workplace breastfeeding support characteristics, job satisfaction, and breastfeeding outcomes among health care employees. Materials and Methods: We used data from a cross-sectional survey of employees in a large integrated health care system. The study sample included female employees who had breastfed in the past 3 years (n = 165). The Employee Perceptions of Breastfeeding Support Questionnaire (EPBS-Q) measured organization, manager, and coworker support for breastfeeding. Regression analyses tested the association between workplace support factors and breastfeeding duration, breastfeeding exclusivity, and job satisfaction. Results: Managerial support increased median job satisfaction by 0.39 standard deviations (p < 0.001), and increased the odds of prolonging exclusive breastfeeding (odds ratio [OR] 1.47; confidence interval [CI] 1.03-2.09). Organizational support increased median job satisfaction by 0.27 standard deviations (p < 0.001), and increased the odds of exclusive breastfeeding by nearly twofold (OR 1.80; CI 1.05-3.09). No significant associations were found between workplace support factors (organizational, managerial, and co-worker support) and overall breastfeeding duration. Conclusions: Organizational and managerial support are key aspects of workplace lactation support, which may positively impact job satisfaction, rates of exclusive breastfeeding, and duration of exclusive breastfeeding among female health care employees. This intersection of outcomes salient for the business community and public health practitioners highlights opportunities for collaborations to improve workplace and breastfeeding outcomes.

Educational Objectives and Skills for the Physician with Respect to Breastfeeding, Revised 2018

The Academy of Breastfeeding Medicine is a worldwide organization of physicians dedicated to the promotion, protection and support of breastfeeding and human lactation. Our mission is to unite into one association members of the various medical specialties with this common purpose.

Female trainees believe that having children will negatively impact their careers: results of a quantitative survey of trainees at an academic medical center

BACKGROUND

Medical training occurs during peak childbearing years. However, the intense workload, long work hours, and limited financial compensation are potential barriers to having children during this time. Here, we aimed to identify gender-based differences in beliefs and experiences of having children during graduate medical education. We hypothesized that both genders face significant challenges, but women are more likely to experience stressors related to work-family conflicts.

METHODS

We administered an anonymous web-based survey to all trainees at an academic medical center. Primary outcomes were gender differences in beliefs and experiences of having children during training. Multivariate logistic regression was performed using independent variables of gender, specialty type (surgical vs. medical), and parental status.

RESULTS

In total, 56% of trainees responded (60% women, 40% men; n = 435). Women were more often concerned about the negative impact of having children and taking maternity leave on their professional reputation and career. The majority of women expressed concern about the potential negative impact of the physical demands of their jobs on pregnancy. Among parents, women were more likely than men to be the primary caregivers on weeknights and require weekday childcare from a non-parent.

CONCLUSIONS

Women face greater work-related conflicts in their beliefs and experiences of having a family during graduate medical education. Trainees should be aware of these potential challenges when making life and career decisions. We recommend that institutions employ solutions to accommodate the needs and wellbeing of trainees with families while optimizing training and workload equity for all trainees.

Lactation Space Experiences and Preferences Among Health Care Workers in an Academic Medical Center

BACKGROUND

Comprehensive workplace lactation support programs can reduce the risk for early breastfeeding discontinuation; however, scant evidence is available to inform user-centered design of employee lactation spaces. This study describes health care workers' preferences for lactation space.

MATERIALS AND METHODS

In 2016-2017, a convenience sample of 151 women who pumped at work at an academic medical center reported on demographics, lactation experiences, and room and equipment preferences through an online survey.

RESULTS

Respondents worked in research and administration (32%), were nurses (30%), physicians and medical students (19%), or allied health or clinical support staff (19%). Seventy percent had ever used one of the hospital's dedicated lactation spaces. Forty-nine percent ranked hospital-grade pumps the most important piece of lactation room equipment; 83% preferred multiple occupancy lactation suites; and the average maximum acceptable distance to lactation space was 5.6 minutes.

CONCLUSIONS

Optimal lactation infrastructure supports the immediate and long-term health of female workers and their children. User needs and preferences can guide design of lactation space to ensure a minimum standard for design, equipment, and distance. Workers may have different preferences depending on roles and experiences; thus, a variety of solutions may be most effective.

Pregnancy and Motherhood During Surgical Training

Importance

Although family priorities influence specialty selection and resident attrition, few studies describe resident perspectives on pregnancy during surgical training.

Objective

To directly assess the resident experience of childbearing during training.

Design, Setting, and Participants

A self-administered 74-question survey was electronically distributed in January 2017 to members of the Association of Women Surgeons, to members of the Association of Program Directors in Surgery listserv, and through targeted social media platforms. Surgeons who had 1 or more pregnancies during an Accreditation Council for Graduate Medical Education-accredited US general surgery residency program and completed training in 2007 or later were included. Important themes were identified using focus groups of surgeons who had undergone pregnancy during training in the past 7 years. Additional topics were identified through MEDLINE searches performed from January 2000 to July 2016 combining the keywords pregnancy, resident, attrition, and parenting in any specialty.

Main Outcomes and Measures

Descriptive data on perceptions of work schedule during pregnancy, maternity leave policies, lactation and childcare support, and career satisfaction after childbirth.

Results

This study included 347 female surgeons (mean [SD] age, 30.5 [2.7] years) with 452 pregnancies. A total of 297 women (85.6%) worked an unmodified schedule until birth, and 220 (63.6%) were concerned that their work schedule adversely affected their health or the health of their unborn child. Residency program maternity leave policies were reported by 121 participants (34.9%). A total of 251 women (78.4%) received maternity leave of 6 weeks or less, and 250 (72.0%) perceived the duration of leave to be inadequate. The American Board of Surgery leave policy was cited as a major barrier to the desired length of leave by 268 of 326 respondents (82.2%). Breastfeeding was important to 329 (95.6%), but 200 (58.1%) stopped earlier than they wished because of poor access to lactation facilities and challenges leaving the operating room to express milk. Sixty-four women (18.4%) had institutional support for childcare, and 231 (66.8%) reported a desire for greater mentorship on integrating a surgical career with motherhood and pregnancy. A total of 135 (39.0%) strongly considered leaving surgical residency, and 102 (29.5%) would discourage female medical students from a surgical career, specifically because of the difficulties of balancing pregnancy and motherhood with training.

Conclusions and Relevance

The challenges of having children during surgical residency may have significant workforce implications. A deeper understanding is critical to prevent attrition and to continue recruiting talented students. This survey characterizes these issues to help design interventions to support childbearing residents.

Barriers to Breastfeeding in Female Physicians

BACKGROUND

Breast milk is considered the normative nutrition for human infants, and exclusive breastfeeding for the first 6 months of life is recommended by several national and global societies. Female physicians are a high-risk group for early unintended weaning. We aimed to assess and compare the most common barriers to successful breastfeeding perceived by female physicians in various stages of training and practice.

MATERIALS AND METHODS

Female faculty physicians and trainees (medical students, resident physicians, and fellows) affiliated with a large medical university in 2016 were surveyed via an anonymous web-based survey distributed through institutional e-mail lists. The three-item survey assessed role, breastfeeding experience, and perceived barriers to successful breastfeeding. Comparisons between groups were performed using Wilcoxon rank-sum tests or Fisher's exact tests.

RESULTS

The survey was distributed to 1,301 women with 223 responses included in analysis. The majority (57%) of respondents had never breastfed; of those, 87% reported plans to breastfeed in the future. Ninety-seven percent of women with breastfeeding experience reported at least one perceived barrier to successful breastfeeding. Trainees identified more barriers compared with faculty physicians (median count 5 versus 3, p = 0.014). No individual barrier reached statistical significance when comparing between faculty and trainees. The most frequently identified barriers to breastfeeding were lack of time and appropriate place to pump breast milk, unpredictable schedule, short maternity leave, and long working hours.

CONCLUSIONS

Physicians and medical students who breastfeed face occupation-related barriers that could lead to early unintended weaning. Trainees and faculty report similar barriers. Institutional support may help improve some barriers to successful breastfeeding in female physicians.

Productive Pumping: A Pilot Study to Help Postpartum Residents Increase Clinical Time

BACKGROUND

Many female residents choose to start families during training, and they want to breastfeed their infants. Continuing lactation while balancing service and education demands can be challenging.

OBJECTIVE

We hypothesized that the presence of a dedicated and fully equipped lactation room with a hospital-grade pump (HGP) would increase ease and efficiency of lactation during residency.

METHODS

A quiet HGP was purchased for resident use, and it was stored in a designated room with a computer, telephone, and dictation system. Lactating residents provided information about pumping time and production using their own portable double electric pump (PP) versus the HGP based on the first pump of the morning (for consistency), averaged over the first month back from maternity leave.

RESULTS

Among 6 residents, lactation time with PP averaged 24 minutes (range, 15-40 minutes) versus 15.5 minutes with HGP (range, 10-32 minutes). Use of the HGP reduced total pumping time by 8.5 minutes (95% confidence interval 3.8-12.2, P = .045). Production volume increased from 6 ounces (range, 3.5-8.5 ounces) with PP to 8.8 ounces (range, 8-11 ounces) with HGP, for a mean increase of 2.8 ounces (95% confidence interval 1.2-4.3, P = .06) despite decreased lactation time.

CONCLUSIONS

In our pilot, an HGP significantly decreased lactation time, while increasing expressed milk volume. Residents completed clinical and educational tasks while pumping. Providing an HGP and equipped lactation space helped residents continue breastfeeding and decreased the burden of lactation on patient care and educational tasks.

Lactation Consultants' Perceived Barriers to Providing Professional Breastfeeding Support

BACKGROUND

Addressing suboptimal breastfeeding initiation and duration rates is a priority in the United States. To address challenges to improving these rates, the voices of the providers who work with breastfeeding mothers should be heard. Research aim: The purpose of this study was to explore lactation consultants' perceived barriers to managing early breastfeeding problems.

METHODS

This qualitative study was conducted with a grounded theory methodological approach. In-depth interviews were conducted with 30 International Board Certified Lactation Consultants across Florida. Lactation consultants were from a range of practice settings, including hospitals, Special Supplemental Nutrition Program for Women, Infants, and Children clinics, private practice, and pediatric offices. Data were digitally recorded, transcribed, and analyzed in Atlas.ti.

RESULTS

A range of barriers was identified and grouped into the following categories/themes: indirect barriers (social norms, knowledge, attitudes); direct occupational barriers (institutional constraints, lack of coordination, poor service delivery); and direct individual barriers (social support, mother's self-efficacy). A model was developed illustrating the factors that influence the role enactment of lactation consultants in managing breastfeeding problems.

CONCLUSION

Inadequate support for addressing early breastfeeding challenges is compounded by a lack of collaboration among various healthcare providers and the family. Findings provide insight into the professional management issues of early breastfeeding problems faced by lactation consultants. Team-based, interprofessional approaches to breastfeeding support for mothers and their families are needed; improving interdisciplinary collaboration could lead to better integration of lactation consultants who are educated and experienced in providing lactation support and management of breastfeeding problems.

The Nuts and Bolts of Breastfeeding: Anatomy and Physiology of Lactation

Breastmilk is the physiologic norm for infant nutrition. Despite recommendations from major health organizations, many women in the U.S. are not achieving this metric. Understanding breast anatomy and lactation physiology will allow physicians to gain knowledge of the processes, which control lactation enabling physicians to appropriately manage the breastfeeding dyad. The interplay of hormones involved in lactation and milk management affect milk initiation, as well as ongoing milk production (galactopoesis). The unique components of breastmilk that provide protection against infection and chronic diseases also change between and during feeds. Colostrum and the importance of early skin-to-skin after delivery will also be discussed.

Promote Breastfeeding in the Outpatient Setting: It's Easy!

The numerous benefits for both mother and baby of breastfeeding are evidence-based and well-defined. Breastmilk is the physiologic norm for infant nutrition, offering multiple health benefits and protections for mothers and babies. Although major medical and health organizations, which represent the health of women and children, such as the American Academy of Pediatrics (AAP), American College of Obstetrics and Gynecology (ACOG), American Academy of Family Practice (AAFP), Centers for Disease Control (CDC), UNICEF, the World Health Organization (WHO) and the National Public Health Service (NPHS), all recommend exclusive breastfeeding, few women meet the recommended goals for duration and exclusivity, despite high initiation rates. This article will discuss the barriers women face when breastfeeding. Strategies will be discussed on how physicians and health care providers can assist and advocate for their mothers while helping to improve the health of women and children. Physicians/pediatricians can support women and design interventions that can help patients' mothers overcome these challenges.

National Trends in Pediatricians' Practices and Attitudes About Breastfeeding: 1995 to 2014

BACKGROUND AND OBJECTIVES

The American Academy of Pediatrics (AAP) has affirmed breastfeeding as the preferred method of infant feeding; however, there has been little systematic examination of how pediatricians' recommendations, affiliated hospitals' policies, counseling practices, and attitudes toward breastfeeding have shifted over the past 2 decades. These trends were examined from 1995 to 2014.

METHODS

Data are from the Periodic Survey (PS) of Fellows, a nationally representative survey of AAP members. PS #30 (1995; response rate = 72%; N = 832), PS #57 (2004; response rate = 55%; N = 675), and PS #89 (2014; response rate = 51%; N = 620) collected demographics, patient and practice characteristics, and detailed responses on pediatricians' recommendations, affiliated hospitals' policies, counseling practices, and attitudes toward breastfeeding. By using bivariate statistics and logistic regression models, the analysis investigated changes over time with predicted values (PVs).

RESULTS

From 1995 to 2014, more pediatricians reported their affiliated hospitals applied for "baby-friendly" designation (PV = 12% in 1995, PV = 56% in 2014; P < .05), and more reported that they recommend exclusive breastfeeding (65% to 76% [P < .05]). However, fewer respondents indicated that mothers can be successful breastfeeding (PV = 70% in 1995, PV = 57% in 2014; P < .05) and that the benefits outweigh the difficulties (PV = 70% in 1995, PV = 50% in 2014; P < .05). Younger pediatricians were less confident than older pediatricians in managing breastfeeding problems (P < .01).

CONCLUSIONS

Pediatricians' recommendations and practices became more closely aligned with AAP policy from 1995 to 2014; however, their attitudes about the likelihood of breastfeeding success have worsened. These 2 divergent trends indicate that even as breastfeeding rates continue to rise, continued efforts to enhance pediatricians' training and attitudes about breastfeeding are necessary.