Breastfeeding Still a Big Barrier to Equity for Health Care Providers
BY MICHELLE COHEN
Previously published in The Medical Post, October 2019
The pace of work in health care can make meeting basic bodily needs a challenge at times. Eating, sleeping, even going to the bathroom can feel like low priorities during a busy shift or call night. This can be especially true of health care workers who are breastfeeding, as finding the time and space to pump milk in a hospital or clinic can be exceedingly difficult.
In Dr. MILK, the online support and educational community for breastfeeding physicians, members share stories about the un-accommodating (or downright hostile) work and training environments in which they struggle to pump milk. Despite the fact that breastfeeding is recognized human right in Canada, and one that employers are required to accommodate, the reality is often far from what the law protects.
In the health care workplace, pumping milk is often not treated as a physiological need, so it fails to even get the essentials that other bodily needs do. Most hospitals provide dedicated spaces (at least for some staff) to eat, sleep or shower, yet few have a room set aside for employees to pump milk. The accommodation for pumping milk is frequently a temporary space like an empty office, patient room or call room, but it can also be an unhygienic and wholly unsuitable space like a bathroom or janitor’s closet.
Adequate time to pump can also be a challenge as even 20 minutes away from clinical duties can be difficult to get. It’s not uncommon to need to pump every 3 hours, particularly earlier in the postpartum period. During long shifts or call nights, one might have to pump multiple times. The consequences of not being able to pump as frequently as needed can lead to painful problems like blocked milk ducts and mastitis. It can also reduce milk supply over the long run and end a breastfeeding relationship earlier than planned.
During lactation is it a physiological necessity to remove milk from the breasts on a regular basis, unless weaning is desired. Not removing milk when needed can cause significant discomfort and lead to both short and long-term complications. Being prevented from pumping milk can also add major stress to the return from maternity leave. Studies show that the burden of balancing family and work demands is a significant factor for women in medicine who experience burnout. Women are also at higher risk of burnout overall, so it’s incumbent upon us to appreciate the struggle many face when returning from maternity leave while breastfeeding.
Along with the difficulty of obtaining adequate time and space to pump, women often face academic penalties or negative career consequences from the perception that they are taking frivolous “breaks” from clinical duties. A survey of women in medicine found that over 35% experienced discrimination relating to motherhood status, and nearly half of those women reported discrimination on the basis of breastfeeding.
Too often the general attitude is that breastfeeding is a trivial lifestyle choice, so when it’s seen as interfering with patient care, the health care provider is seen as not dedicated enough to their work. The underlying machismo of health care (wherein sacrifice is a badge of honour) along with its legacy of misogyny creates an environment in which needing to pump milk is an unimportant and even shameful burden to be borne alone by the breastfeeding worker or trainee.
Canadian Women in Medicine (CWIM), a group founded to support, connect and advocate for women physicians, is working towards better protections for pumping milk in the workplace. Physicians who breastfed during residency are invited to complete this survey and let CWIM know about your experiences. Preliminary results show nearly 40% of breastfeeding residents experienced a complication like blocked milk ducts, mastitis or reduced milk supply from not being able to pump as frequently as they needed. We need more data on medical students and attending physicians, as well other health care workers and trainees, the large majority of whom are women and so at high risk of encountering these struggles when starting or expanding their family.
So what can we do to better support our health care colleagues who are breastfeeding? First and foremost, we need to appreciate that pumping milk at regular intervals is a physiological need, one that can have medical consequences if not accommodated. Furthermore, pumping milk in the workplace is a recognized human right in Canada, so employers are required to ensure that adequate space and time are granted without any penalties. In spite of this protection in the law, the reality is often that adequate accommodations aren’t available, so school and workplace policies are needed to ensure those rights are upheld.
Some organizations are taking the responsibility to protect breastfeeding employees and trainees seriously, providing dedicated space and protected time for pumping milk. At The Ottawa Hospital, anesthesiologist Dr. Miriam Mottiar found it challenging to work in the OR all day with no scheduled breaks or protected space to pump milk. Her strong advocacy led to a lactation room and written policies that support breastfeeding employees.
At the Northern Ontario School of Medicine (NOSM), 3rd year medical student Kaitlin Gonzalez spearheaded a policy that protects the rights of all NOSM trainees to pump milk, including when they are training off-site in any Ontario hospital. Dean of NOSM, Dr. Sarita Verma, says the new policy “is about the NOSM commitment to a culture of wellness and kindness,” adding that “as a woman dean I ‘got it’ right away when approached to support facilitating breastfeeding in the workplace and school.” Dr. Verma hopes other schools will follow in NOSM’s footsteps and adopt similar policies.
Working at the level of individual hospitals and universities is effective but small scale. Provincial residency associations, on the other hand, have a unique opportunity to codify protections for breastfeeding residents in their employment contracts. This would capture a large number of physicians at roughly the age when pumping milk is a common issue. Of the eight residency associations in Canada, not a single one’s contract contains language on accommodations for breastfeeding, a distressing lag in representation of the growing number of women in medicine. CWIM has reached out to each residency association and hopes to work in partnership with them to establish breastfeeding protections in all contracts.
Ultimately, what’s needed to accommodate breastfeeding health care workers is fairly basic. A policy granting 20 minutes of pumping time at least every 3 hours would suffice for frequency. Lactation rooms aren’t complicated to design – the requirement is simply a clean space with a seating area, an electrical outlet and a sink. Ideally the room wouldn’t be located far from patient care areas to help facilitate easy access. Milk bottles are typically kept in a food-grade cooler bag that’s taken home at the end of the day. This cooler bag can be stored in a dedicated lactation fridge, however any common area fridge (such as in a lunch room) is perfectly acceptable.
Changing the culture of health care so that penalties like unfavourable evaluations or lack of promotions don’t happen is much harder than writing a few breastfeeding protection policies. However, conversations like these and the individual advocacy of champions like Dr. Mottiar and Ms. Gonzalez help push us forward towards equitable treatment of all health care providers at all stages of family life.
Michelle Cohen is a family physician in Brighton, Ontario and an assistant professor in the Queen's Department of Family Medicine. She's also the Advocacy Chair for Canadian Women in Medicine and a general trouble maker and rabble rouser on social media.