Improving Lactation Culture in Medicine

By Jessica Buesing, MD, Chief Resident

When I started medical school at the age of twenty-seven, I already knew that I wanted to have children during training. I remember a formative conversation with one of my mentors, a mother of four. I went to her office during my second year to ask when the right time was to have children. Her answer was so simple and refreshing: “Whenever you want them.” We talked about issues of infertility in physicians and she encouraged me to do what was right for me. Hearing these words from an academic physician gave me confidence that I could have some control over both my personal and professional lives.

Before giving birth I didn’t appreciate just how truly all-consuming breastfeeding is. The ignorance around lactation and barriers to pumping were truly astonishing to me as I tried to navigate being a medical student and a mother simultaneously. My son was born right as I was beginning the process of applying to residency. My first clinical rotation back after giving birth showed me just how little infrastructure exists to support lactating parents. In order to exclusively breastfeed my son, I needed to pump every four to five hours. If I pumped in the morning before getting to my rotation, I would inevitably have to leave rounds to pump for the second time of the day. This usually meant leaving my clinical duties and going to another building to retrieve my bag, walking to yet another building to find an open lactation room, pumping for twenty to thirty minutes, going to a bathroom to wash my pump parts, racing back to the building where I could store my belongings, and then returning to the main hospital to continue rounding with the team. Because everything was so spread out this reliably took me over an hour every time.

I thought it was my fault – why was I so inefficient? I found it unsustainable, embarrassing, isolating and exhausting; moreover, I was worried that my performance as a student was suffering. I started to space out pumping sessions to avoid leaving, and soon became extremely ill with mastitis. I often use this story to remind people that pumping is not a luxury – it is a medical necessity.

"If institutions like Stanford want to recruit the best talent, we need to celebrate parents and lactation and create an inclusive, supportive environment.

That experience taught me that institutions need to be adequately prepared to support lactating parents, and unfortunately many are not. They need to provide ample private space for pumping, refrigerators for milk storage, and sinks in sanitary areas (not bathrooms) where people can clean pump parts between pumping sessions. There is a need for computer workstations to pump and work at the same time, and a culture of support and understanding is paramount. Before residency interviews, I was encouraged not to disclose to programs that I was a parent, and to discreetly ask residents where I could pump. I found this advice frustrating. How could I know if a program were a good fit if they could not demonstrate their willingness to support me as a parent? I decided to take control of the narrative and I began to ask programs how they supported parents. Did they have lactation rooms? Did they have on-site daycare? How many residents were parents? The responses to these questions were extremely telling. On my interview days, some programs offered for me to pump in public classrooms. Others offered locker rooms, and some put me in administrators’ offices. Although it was nice that they tried to accommodate me, it was eye opening that many excellent programs did not have accessible lactation rooms.

As increasing numbers of non-traditional students enter the medical profession, the number of trainees that have children and need to pump is only going to increase. I had my second child during residency and found pumping at Stanford more manageable than it had been at my prior institution; but even so, lactation rooms are often occupied, there is no milk storage available, there are no computer stations in the new lactation rooms, and I still often had to clean pump parts in bathroom sinks. Pumping, breastfeeding, and cleaning pump parts took me four to five hours a day, seven days a week. This means I dedicated about thirty hours per week to nursing my child in addition to seventy to eighty hours per week of clinical work. It was, to say the least, exhausting.

To make breastfeeding feasible, we need unwavering support from our colleagues and institutions. This starts with simple changes that each of us can do:

1 Help colleagues find time

If you know someone on your team is pumping, help them find times throughout the day to step out and pump; maybe cover their pager.

2 Don't shy away from conversations

Don’t shy away from conversations about pumping and lactating – many people feel lonely navigating these challenges by themselves.

3 Make team members feel comfortable

Encourage team members to feel comfortable pumping in team rooms.

4 Use supportive language

Use supportive language and acknowledge the tremendous amount of work they are doing to nourish their child.

What I hope programs in all specialties will begin to do is preemptively tell applicants that they support parents. If institutions like Stanford want to recruit the best talent, we need to celebrate parents and lactation and create an inclusive, supportive environment.