ADVOCACY UPDATE: Results of CWIM’s Survey on Breastfeeding Accommodations in Medical Residency Programs
BY: MICHELLE COHEN
Pumping Breastmilk in Residency Survey
CWIM conducted an informal survey in the fall of 2019 that asked physicians with experience breastfeeding during residency about pumping breastmilk at work. We had heard enough horror stories from colleagues about having to pump in the bathroom, or suffering a painful complication from not having time to pump, or getting hit with an academic penalty for pumping. We wanted to put some numbers behind those stories as part of our advocacy for better pumping accommodations for all breastfeeding health care workers.
We received 170 responses to our survey asking physicians who have breastfed/are currently breastfeeding during a Canadian medical residency about their workplace accommodations. All eight of the regional residency associations were represented in the responses. 28% respondents pumped milk at work for more than six months. 58% pumped for more than three months.
Over 67% of respondents felt they didn’t have adequate time to pump at work and nearly 73% felt they didn’t have adequate space.
More than 63% felt they didn’t have adequate storage for pumped milk, meaning nearly two-thirds of respondents didn’t have access to enough fridge space to store a small cooler bag.
Breastfeeding is governed by the physiological need to empty the breasts of milk at regular intervals. If this physiological need is not met, complications such as mastitis, blocked milk ducts or reduced milk supply can occur. 40% of respondents felt that not being able to pump as frequently as needed caused them to develop one of those complications.
This suggests that a breastfeeding resident has a significant chance of developing a painful acute condition, one that might require antibiotics, as a direct result of poor pumping accommodations in the workplace.
Reduced milk supply can have a long-term effect on breastfeeding, which might be the major reason that nearly 32% of respondents didn’t meet their personal breastfeeding goals.
Respondents didn’t strongly endorse feeling supported by their academic institutions and representative bodies. 47% felt that their residency program didn’t support their pumping needs and nearly one-third reported facing either criticism from the health care team or academic penalties for needing to pump.
Just over 55% felt that their regional residency association – the organization responsible for negotiating and protecting labour rights in residency – was unsupportive of their pumping needs.
This is one of the reasons CWIM is calling for regional residency associations to take a more active role in protecting the rights of breastfeeding residents.
Regional residency associations can formalize pumping accommodations in their residency labour contracts. They can work pro-actively with clinical teaching sites and universities to ensure adequacy of accommodations. They can educate resident members on their rights as breastfeeding workers to employer-provided accommodations in the workplace.
We have reached out all of the Canadian residency associations to try to work together on this important but overlooked issue. So far, there is little interest on their parts in working with CWIM, but we remain hopeful that this will change in the future.
In Their Own Words
Here are some of our survey respondents in their own words describing their experiences breastfeeding during a Canadian medical residency:
“I was an anesthesia resident - it was discouraged to pump (eg non supportive attendings, no place to pump, not seen as a priority over education, was told ‘in real life’ when I was staff there wouldn’t be time to pump) so even just not getting grief about stepping out for 20min would have been nice! Plus somewhere to do it other than a bathroom stall.”
“My pumping experience during my NICU fellowship in Ontario was anxiety-riddled and devastating. There are literally NO accommodations for breastfeeding staff at the CHILDREN'S hospital where I work and I have pumped in the locker room/call room previously. I leaked through all of my shirts at work and lost my milk supply.”
“Actually, I don't even know what my association does to support pumping residents.... So maybe ‘advertise’ more their position so we can use their policies to demand more accommodations during our rotations.”
“My first rotation back at 6 months post-partum was general surgery. I had explained to my preceptor and my program that I planned to continue to breastfeed which would mean pumping several times a day (at least initially). My gen surg preceptor wrote on my evaluation (under room for improvement), ‘resident frequently took breaks from clinical work to feed her child’ and gave me a... Partial pass? Can't recall what the actual term was. Fought this tooth and nail and received absolutely ZERO support from my female program director. When asked about pumping space I was told to use the lactation consultant's room while in the hospital (which was often full or not accessible). I also had nowhere to keep my milk, was told it was a body fluid so staff/food fridges were out. I got a freezer bag and managed.”
“You were just kind of left on your own to make time, find space, etc. There was certainly no designated spaces and finding a fridge to put breastmilk in was always a challenge from rotation to rotation.”
“There was no protected space for residents to pump. I had to borrow space from allied health to pump (hence the backlash for using their space). I also was pleading to use their fridge to store the milk. It was not a Pleasant experience. However, I found that it was very site specific. I moved to a different hospital and the experience was completely different.”
“I had three kids in residency and in total probably pumped for 1 year. It was hardest with my first as I came back to work at 3months. I had to pump frequently but could only pump at lunch and after clinic. Always felt rushed. Has multiple bouts of mastitis. Kept my breast milk in a cooler with ice pack that my husband would need to pick up and exchange empty bottles for when I was on overnight call. Pumped in the washrooms or in a closed clinic room.”
“There was zero support. I pumped in the bathroom, sitting on the floor, while simultaneously dictating consults / OR notes etc. Then kept my milk in the patient’s fridge on the ward. I often was criticized for being late to rounds/clinic bc I was pumping.”
“I was told it would be unrealistic as a senior surgical trainee to return to work and continue breastfeeding/pump at work. I had to return to work at 12weeks post partum to remain Royal College eligible. I lost my already tenuous supply completely within a week after scrubbing for cases >10hrs long with no break to eat or to pump.”
“I expected MUCH more empathy from an Ob/Gyn program on an obstetrics rotation with neonatal ICU next door in the hallway. You would think they would let a pumping resident share space with the new moms. I had to do it in a bathroom stall and get nasty comments from the nurses about where I could store my milk. My attending would only let me pump once a day at lunch which cut my supply down to zero in 1-2 weeks. I was 3 months post-partum, totally devastated and made to feel humiliated and inadequate as a resident and as a mom.”