Let’s help new mom physicians (and their patients) to breastfeed

Reading time:  5:30 mins

Physicians know the importance of breastfeeding. But what happens to new-mom physicians? How easy is it for them to take their own advice?

The Canadian Infant Feeding Joint Working Group, comprised of Health Canada, Canadian Paediatric Society, Dietitians of Canada and the Breastfeeding Committee for Canada have issued two statements on breastfeeding – birth to 6 months, and 6 – 24 months. The recommendations are to breastfeed exclusively for the first 6 months; post 6 months, continue for as long as possible, up to 2 years or longer. Other foods, particularly iron-rich foods, as well as vitamin D supplements can be introduced after 6 months and in line with baby’s indications of readiness.

In Canada, breastfeeding among new moms is trending upward, with 89% of mothers reporting breastfeeding in 2011-12. Significantly, the number of women breastfeeding to 6 months rose from 17% in 2003 to 26% in 2011-12. The most common reasons for the average Canadian women to stop breastfeeding are lack of milk and difficulty with technique. For women physicians however, the most cited reason is more complicated: the demands of the job.

According to Statistics Canada, 64% of mothers with children under 3 are in the workforce. Research has demonstrated that longer maternity leave leads to greater take up of breastfeeding. Parental leave legislation has improved over the last several years, with the government guaranteeing 18 months workplace leave – 12 years paid through Employment Insurance (EI), 6 months unpaid. Government maternity leave benefits do not apply to self-employed women, such as doctors, lawyers, etc. Private insurance can be purchased, or the mother can save from her income to cover her maternity leave.

But insufficient maternity leave is not all there is to the problem.

There’s something seriously wrong with the physician work culture when nursing physician moms are stymied from following their own good advice due to the systems in which they work. The impact goes further than the mother/child connection; it touches on patient-care, for nursing physicians are more likely to promote and support breastfeeding for new mothers. It stands to reason that assisting physician moms to initiate and continue breastfeeding for themselves could lead to more Canadian mothers initiating and continuing to breastfeed their own children for as long as they consider appropriate.

While breastfeeding initiation is high among new mom physicians, premature breastfeeding cessation is a real risk. A 2013 study by Sattari et al, found that while 97% of new mom physicians initiated breastfeeding and 57% planned to be breastfeeding at 12 months, only 34% of children were receiving breast milk at 12 months. Work demands were cited as the main reason for stopping. Women physicians who advocated for breastfeeding among their patients and staff were more likely to experience longer duration of breastfeeding. A 2018 research letter published in the Journal of the American Medical Association echoed these findings. The authors note that longer maternity leave, flexibility for pumping, and access to a private space can improve breastfeeding rates.

Maternity leave is crucial to providing new moms with the time they need to establish a breastfeeding routine and ensure an adequate milk supply, which can take between 1-3 months. During this period, there should be minimal separation of the mother and child. Breastfeeding can be challenging; the technique of “latching on” can be difficult for some moms, sore and cracked nipples is a common complaint. The inability to establish a regular feeding schedule with baby may result in engorgement, mastitis, plugged ducts or abscesses. Emptying the breasts is essential to maintaining an adequate supply of milk.

Maternity leave can be problematic for new mom physicians. It’s not that simple for them to step outside of their practice, their career or their education for extended periods of time. Medical students typically can get a program accommodation, residents are considered employees of their hospitals and are eligible for government maternity leave, however, the resident system does not easily lend itself to accommodation. Pregnant and new mothers report perceived and real repercussions from fellow residents and program directors for requesting scheduling changes and taking time to express milk.

Upon returning to work, new moms are faced with a range of challenges that create barriers for breastfeeding mothers.

• Quiet, private space to express milk,
• Time to express milk – it can take up to 30 minutes to express milk adequately
• Secure storage for expressed milk, containers and breast pump
• Inflexibility in scheduling nursing mothers – women who work shift work are less likely to breastfeed

What are the solutions?

• On site daycare for nursing infants. This is the “gold standard” according to the Academy of Breastfeeding Medicine
• Lactation room for expressing milk. Somewhere quiet and private, but not so far away it takes too long to get there and back to work.
• Protected time to pump. This is crucial to staying the course. Protected time is needed to counter the tendency of considering women’s needs as periphery and their commitment to school, training and work as less than their male or non-lactating colleagues.
• Adequate time to pump. Physicians work extremely long hours, so it is critically important for moms to have time to express adequately to avoid the health risks that come with engorgement such as mastitis, plugged ducts and abscesses. It is suggested that breastfeeding moms be relieved of clinical duties for 30 minutes every 4 hours.
• Dedicated and secure fridge with freezer for storage
• Dr. MILK, where you can find evidence-based support and education for physician women to assist them in reaching their breastfeeding goals and apply that knowledge to their medical practice.

What are the benefits of accommodating breastfeeding mothers?

• Reduced sick leave.
• Improved staff retention, productivity and loyalty.
• Increased take up of breastfeeding in the general population.
• Healthier babies, healthier people.

Accommodating breastfeeding physician moms should be on the radar of provincial physician associations as a workplace right. Where are they on this issue? Who is responsible for ensuring breastfeeding physician moms are supported in their workplace? Is it up to individual hospitals? What about medical school? Do any of them have a lactation room? Or is it up to new moms to figure it out and fight for it themselves?

Is there anyone doing this right?

Tell us your experience as a breastfeeding mom. What did you need? Where did you find support? What advice do you have for new physician moms?

We want to hear from you!

Dr. Bev Johnson National President Federation of Medical Women of Canada

Dr. Michelle Cohen Advocacy Chair Canadian Women in Medicine

Mangurain, C., Linos, E., Sarkar, U., Rodriguez,. C., & Jagsi, R. “What’s holding women in medicine back from leadership”. Harvard Business Review, June 19, 2018.

Marinelli, KA, Moren, K., Scott Taylor, J., Academy of Breastfeed Medicine, "Breastfeeding Support for Mothers in Workplace Employment or Educational Settings: Summary Statement". Breastfeeding Medicine 8 (1) 2013.

Melnitchouk, N., MSc, Scully, RE.,Davids, JS."Barriers to Breastfeeding for US Physicians Who Are Mothers", JAMA Intern Med2018;178(8):1130-1132. doi:10.1001/jamainternmed.2018.0320.

Sattari. M, Levine, D., Neal., Serwint, JR., 'Personal Breastfeeding behaviour of physician mothers is associated with their clinical breastfeeding advocacy". Breastfeeding Medicine, 2013 , Feb: 8 (1): 31-7.