Are We Really “Baby Friendly?” :

As pediatricians, breastfeeding is a topic that is near and dear to our hearts. In a recently released article in Pediatrics(10.1542/peds.2019-1279), Dr. Danzier describes her personal experience of breastfeeding as a trainee (over 70 months total!) and demonstrates that while the medical community continues to raise awareness of the benefits of breastfeeding and to increase cultural acceptance, we have done very little to better enable our own working mothers to breastfeed.

To start, many teaching hospitals don’t have a formal paternity or maternity leave policy and often require trainees to file for Family Medical Leave – effectively equating pregnancy to a family emergency or illness. In many situations, this means unpaid leave, using all of one’s vacation days or feeling forced to take only minimal time off. How can we expect our students and residents to breastfeed for 6 months when we hardly allow time for breastfeeding to be well established in the first place?

Even if a woman successfully breastfeeds at home, the structure and culture of hospital medicine does not lend itself naturally to the logistics of breastfeeding. Though I don’t have children of my own, I relate strongly to Dr. Danzier’s experience. Many of my former resident female colleagues voiced discomfort or a feeling of shame with the need to take a 20 min break from clinical work to pump, forcing themselves to wait way past the point of comfort and often sacrificing educational time to do so. This experience is shared among trainees across the country in various specialties. ^1,2,3

I also witnessed how the lack of a private lactation space in the hospital led many of my fellow residents to pump in a female attending’s office to avoid doing so in public bathrooms or a cramped closet space shared with NICU mothers. Many also mentioned their embarrassment at needing to leave pumped breast milk in the resident fridge next to other’s lunches. It’s no wonder so many women stop breastfeeding after returning to work. ^4,5.

It is possible to create a different experience at work. Companies such as Cigna and Texas Instruments have established practices to reduce these barriers by providing mothers with a portable breast pump and necessary supplies as well as access to private or semi-private lactation rooms in all offices. Both companies also encourage employees to set a milk expression schedule that they can arrange with their supervisor. ⁶ Some hospitals have also implemented similar changes such as the Children’s Hospital of Philadelphia, which was recently named among the top breastfeeding-friendly businesses in the country ⁷. But the majority have not.

I agree wholeheartedly with Dr. Danzier that it’s time to walk the walk; we owe it to ourselves and our peers to create as supportive and encouraging of an environment for breastfeeding as we envision for our patients. We must advocate within our own institutions to necessitate changes that promote adequate parental paid leave as well as protected time and space for nursing mothers to continue breastfeeding once they return to work. Then will we truly be able to call ourselves “baby friendly.” 

References

1. Ames, Elizabeth G., and Heather L. Burrows. “Differing Experiences with Breastfeeding in Residency Between Mothers and Coresidents.” Breastfeeding Medicine, 2019, doi:10.1089/bfm.2019.0001.
2. Orth, Teresa A., et al. “Breastfeeding in Obstetrics Residency: Exploring Maternal and Colleague Resident Perspectives.” Breastfeeding Medicine, vol. 8, no. 4, 2013, pp. 394–400., doi:10.1089/bfm.2012.0153.
3. Dagher, Rada K., et al. “Determinants of Breastfeeding Initiation and Cessation among Employed Mothers: a Prospective Cohort Study.” BMC Pregnancy and Childbirth, vol. 16, no. 1, 2016, doi:10.1186/s12884-016-0965-1.
4. Guendelman, S., et al. “Juggling Work and Breastfeeding: Effects of Maternity Leave and Occupational Characteristics.” Pediatrics, vol. 123, no. 1, 2009, doi:10.1542/peds.2008-2244.
5. Kimbro, Rachel Tolbert. “On-the-Job Moms: Work and Breastfeeding Initiation and Duration for a Sample of Low-Income Women.” Maternal and Child Health Journal, vol. 10, no. 1, 2006, pp. 19–26., doi:10.1007/s10995-005-0058-7.
6. Slavit, W., et al. “Investing in Workplace Breastfeeding Programs and Policies: An Employer’s Toolkit.” Washington, DC: Center for Prevention and Health Services, National Business Group on Health; 2009.
7. Children's Hospital. “CHOP Named Among Top Breastfeeding-Friendly Businesses.” Children's Hospital of Philadelphia, The Children's Hospital of Philadelphia, 26 Feb. 2014, www.chop.edu/news/chop-named-among-top-breastfeeding-friendly-businesses.