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

Physician mothers have some of the highest rates of breastfeeding initiation; however, their rates of continuation of breastfeeding to 12 months of age drop substantially from 97% to 34%.1 Major barriers include difficulty finding time and a place to express their milk while at work, competing demands from work and family, as well as perceived lack of employer support.1,2 Less than one-third of physician mothers are able to reach their personal breastfeeding goal, with more than one-half stating that they would have breastfed longer if their “job had been more supportive.”3 Insufficient opportunities to express milk can not only lead to 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 factors are specific to early cessation of lactation in physician mothers, including the shame and stigma around breastfeeding4 and taking breaks from patient care, teaching, and even research to express milk during working hours.2 This is especially a problem for fields where physician mothers are involved with operating room and procedural duties.5 Furthermore, physicians often work in teams and taking a break may affect other team members, or the work cannot continue without the physician (eg, operating rooms or procedural spaces). Unfortunately, anecdotes of physician mothers being suboptimally supported in lactation in the workplace are not uncommon, even in pediatrics. Although many behaviors around expressing milk in the workplace are “tolerated” by employers, these behaviors are not explicitly protected as rights of the employee by many institutions. The Affordable Care Act6 mandates that employers provide lactating mothers with “reasonable break time and a private space to express breast milk,” however, these accommodations are minimal and many employers, including hospital systems, have not extended their policies or cultures to increase support for their lactating employees.