Pediatricians Advocating Breastfeeding - Let's Start with Supporting our Fellow Pediatricians First_2019.pdf

Physician mothers have some of the highest rates ofbreastfeeding initiation; however, their rates of continuationof breastfeeding to 12 months of age dropsubstantially from 97% to 34%.1 Major barriers include difficultyfinding time and a place to express their milk while atwork, competing demands from work and family, as well asperceived lack of employer support.1,2 Less than one-third ofphysician mothers are able to reach their personal breastfeedinggoal, with more than one-half stating that they would havebreastfed longer if their “job had been more supportive.”3Insufficient opportunities to express milk can not only leadto a physician mother not meeting her own lactation goals,but also to blocked ducts, mastitis, decreased milk supply,feelings of inadequacy, stress, and burnout.4 Several factorsare specific to early cessation of lactation in physician mothers,including the shame and stigma around breastfeeding4 andtaking breaks from patient care, teaching, and even researchto express milk during working hours.2 This is especially aproblem for fields where physician mothers are involved withoperating room and procedural duties.5 Furthermore, physiciansoften work in teams and taking a break may affectother team members, or the work cannot continue withoutthe physician (eg, operating rooms or procedural spaces).Unfortunately, anecdotes of physician mothers beingsuboptimally supported in lactation in the workplace are notuncommon, even in pediatrics. Although many behaviorsaround expressing milk in the workplace are “tolerated” byemployers, these behaviors are not explicitly protected asrights of the employee by many institutions. The AffordableCare Act6 mandates that employers provide lactating motherswith “reasonable break time and a private space to expressbreast milk,” however, these accommodations are minimaland many employers, including hospital systems, have notextended their policies or cultures to increase support fortheir lactating employees.

医师母亲（physician mothers）的母乳喂养启动率（breastfeeding initiation）位居各群体前列；然而，其母乳喂养持续至婴儿12月龄的比例却从97%大幅降至34%¹。主要阻碍包括工作期间难以找到抽吸母乳的时间与私密场所、工作与家庭的双重需求冲突，以及感知到雇主缺乏支持¹,²。仅有不到三分之一的医师母亲能够达成自身的母乳喂养目标，超过半数的受访者表示，若“工作给予更多支持”，她们会坚持更久的母乳喂养³。抽吸母乳的机会不足不仅会导致医师母亲无法达成自身的泌乳（lactation）目标，还可能引发乳腺导管堵塞、乳腺炎（mastitis）、泌乳量减少，以及胜任感缺失、压力与职业倦怠（burnout）等问题⁴。医师母亲泌乳早期中断存在若干专属风险因素，包括母乳喂养相关的羞耻感与污名化⁴，以及在工作时间暂停患者诊疗、教学甚至科研工作以抽吸母乳所带来的困扰²。对于需要承担手术室操作与有创操作职责的科室而言，这一问题尤为突出⁵。此外，医师通常以团队形式开展工作，暂停工作可能影响其他团队成员，或在医师离岗后工作无法继续（例如手术室或操作间场景）。遗憾的是，医师母亲在工作场所获得的泌乳支持欠佳的传闻并不少见，即便在儿科（pediatrics）领域亦是如此。尽管许多雇主对职场抽吸母乳行为持“容忍”态度，但多数机构并未将此类行为明确作为雇员权利予以保护。《平价医疗法案》（Affordable Care Act）⁶规定雇主需为泌乳母亲提供“合理的挤奶休息时间与私密空间”，但此类配套措施极为有限，包括医院系统在内的诸多雇主并未调整相关政策或职场文化以加强对泌乳雇员的支持。