Can You Breast-feed During Residency?

Sara Cohen, MD

Disclosures

June 22, 2010

Question

Is it possible to breast-feed your infant as a resident?

Response from Sara Cohen, MD
Fellow, Polytrauma/Brain Injury, VA Boston Healthcare System, Jamaica Plain, Massachusetts

When I gave birth to my daughter 3 years ago, I didn't know anything about breast pumping. I didn't own a breast pump, and I had no idea what to do with the bag full of plastic equipment that they gave me at the hospital, which looked like something I would have found in my premed chemistry class. I was about to go on maternity leave for 2 months, so I put pumping on the back burner, assuming it was something I would deal with later.

"Later" came much sooner than I thought. At 6 weeks postpartum, I was frantically figuring out how to assemble the pieces of the breast pump and build up a supply of milk that would be available when I went back to work. If I could do things over again, I would have forced myself to start pumping at least once a day immediately after coming home (the early morning is the best time). I was always about a few days away from running out of milk, which was a source of ongoing stress for me.

A recent study in the journal Pediatrics [1]found that if most new mothers breast-fed during the first 6 months of life, it would save nearly 1000 lives and billions of dollars each year. As physicians, we know that breast-feeding is healthy for the babies, can prevent sudden infant death syndrome, and boosts immunity. But at the same time, there's a challenge associated with being in medical training and attempting to nurse exclusively.

I was fortunate. One of the attending physicians in my residency program worked with me and arranged for my first rotation back from maternity leave to be a 3-month block on an inpatient rehabilitation unit, where the census was low and there were few emergencies. There was an empty office that wasn't being used, so I would slip away, once after rounds and once in the afternoon, to pump milk. I had my pager with me so that I could call back about any issues, and I was lucky enough not to have any emergencies arise during my pumping time. I also had a co-resident who was nice enough to cover for me if necessary. I was also fortunate that physical medicine and rehabilitation residents didn't have in-house call, so I was always able to come home at night.

On my next rotation, I was not as fortunate. I was the lone resident on a large unit where many of the patients were quite sick. There was no convenient place to pump, either -- the hospital had a beautiful pumping room that was a 10-minute walk across the entire hospital. My daughter was almost 6 months old by this point, so I cut my pumping down to 1 harried session per day and supplemented with occasional formula. At the 6-month mark, I hung up my pump and just nursed in the morning and at night until my daughter turned 1 year old and decided she'd had enough.

A friend of mine was outraged when I told her how difficult it was trying to pump during residency. She cited laws stating that employers are required to provide me with time and resources to pump. That sounds good in theory, but in practice, it doesn't make much sense. When you're a resident taking care of a sick inpatient unit, you can't tell a patient with chest pain to wait 20 minutes while you finish pumping. Sometimes there's coverage available, but not always. The patients' lives are your primary responsibility.

With that in mind, these are my tips for women who are considering breast-feeding during residency:

  1. Start pumping early! Maternity leave may be more exhausting than internship, but force yourself to pump at least once a day, at a time when your supply is most plentiful.

  2. Don't wait too long to introduce bottles to your baby. A lot of new mothers get worried about nipple confusion, but I also know many women who, when ready to go back to work, discovered that their baby was refusing bottles.

  3. Consider getting a pumping band. Invest in something that will allow you to pump one-handed so you can get work done (and return pages) during your break.

  4. Do whatever you can to make things easier for yourself. You might consider getting 2 pumps, a cheap one for home and a nice one for work, so you don't have to lug the pump back and forth. And buy lots of extra supplies, so you don't have to do a wash every hour.

  5. Try to arrange in advance for your first rotation after maternity leave. If possible, try to get something with hours that permit pumping.

  6. Take care of yourself, too. This is my most important tip of all. Breast-feeding is not feasible for everyone. For example, if you're starting a surgery internship, it may just not be possible (or advisable) to pump several times a day. It's important for the mother to be healthy and happy, so if pumping is going to push you over the edge, know that it's okay not to do it. What I regret most is all the hours I spent feeling guilty over every ounce of formula my daughter got. If you love and take good care of your child, that is what matters most.

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