PUMP IT UP: Tips for EM physician mothers who need to pump at work

By Sara Andrabi, MD

Conservative estimates show that one year of breastfeeding equates to approximately 1,800 hours of a mother’s time. A full-time job with 40-hour work weeks and vacation factored in adds up to 1,960 hours. So, it is no surprise that 79 percent of women start breastfeeding, but only 27 percent continue at 12 months. Keep in mind that there are various reasons why mothers may be unable to or choose not to breastfeed or pump, and this does not make anyone less of a mother. This article is not meant to stigmatize anyone who does not breastfeed; this is merely meant to discuss how one can support breastfeeding and pumping in the workplace.

Before returning to work from maternity leave, talk with departmental leadership about what resources are available for pumping in the workplace. All hospitals have some form of a pumping room, but proximity to the department is important in emergency medicine. Some departments have dedicated rooms for pumping within the emergency center. Ask to see what is available. If you are exclusively breastfeeding, start pumping before returning to work to get familiar with pumping equipment, how to clean it, what all is needed, etc. You can also pump after feeds or between feeds. Most suggest pumping as often as your baby feeds. Extra milk can be stored in the freezer for future use, and milk supply can increase with more frequent pumping.

Insurance covers a breast pump, so get one. There are so many different varieties that have come to market since I had my first child. These range from the classic, plug-in pump to the wireless wearable varieties that allow you to be mobile. Figure out what will work best for you and your work expectations. For example, if you work in a single coverage facility, a pump that allows you to be mobile may be the best option. Pumps that allow you to be mobile include the Willow, Elvie, and Freemie (which was actually developed by ACEP member, Stella Dao, MD, FACEP).

After returning to work, most moms find it is easiest to pump right before the shift and right after shift. Most can fit in one or two pumping sessions during shift depending on the length of the shift. Various companies now make breast pumping handbags that have different compartments for pumps, parts, ice packs, snacks, water, etc. to easily organize all equipment necessary to pump. A common misconception is that all pump parts have to be washed after every pumping session. A time-saving alternative is to put pump parts in a Ziploc bag and place that bag in fridge in between pumping sessions, allowing you to wait to clean equipment at home or after your shift. This saves 5-10 minutes each pumping session.

If you decide to go with a pump that requires you to be stationary, invest in a hand-free corset that allows you to chart and eat during pumping sessions. There is nothing worse than forgetting pumping parts at home! If this happens, most hospitals have pumping supplies available that you can use. Specimen cups make for great milk storage containers should you forget to bring yours to work!

The tides are changing, and there is growing encouragement to support breastfeeding moms in the workplace by various organizations. The Accreditation Council for Graduate Medical Education (ACGME) has also realized the importance of supporting breastfeeding. Recent changes to the common program requirements state that “programs and sponsoring institutions must ensure healthy and safe learning and working environments that promote resident well-being,” specifically listing a requirement for “clean and private facilities for lactation that have refrigeration capabilities, with proximity appropriate for safe patient care.”

The Patient Protection and Affordable Care Act requires employers to provide “reasonable break time for an employee to express breast milk for her nursing child for 1 year after the child’s birth each time such employee has need to express the milk.” They are also required to provide “a place, other than a bathroom, that is shielded from view and free from intrusion from coworkers and the public, which may be used by an employee to express breast milk.”

ACEP endorses “the availability of a private, non-bathroom area for breastfeeding emergency department employees, nurses, and physicians to express breast milk during their workday inside or directly proximal to the emergency department.” ACEP also “supports the education of emergency department provider employers and hospitals on the benefits of breastfeeding support in the workplace for infants, mothers, and the business of emergency medicine.”

Social media resources serve as a great source of support from other working moms who are breastfeeding/pumping while working. I particularly learned a lot from the Facebook group Dr. Milk, an online community of physicians interested in lactation knowledge. At the department level, one can support lactating moms by developing policies to address pumping and breastfeeding in the workplace. Our department at Baylor College of Medicine developed a policy that delineated handing off clinical responsibilities, places to pump, etc. for individuals ranging from learners in the department to physicians. You can also support colleagues by recognizing that they may need to pump during shift and encouraging them to do so (some may be too scared to ask or leave their clinical responsibilities). As a departmental leader, you can have a conversation with moms who are returning to work about their plans to breastfeed and how you can be supportive. The more we normalize pumping at work, the more we can encourage and support our lactating moms in the workplace.

Sara is an attending physician. She is the Assistant Medical Director at Ben Taub Hospital Emergency Department and Assistant Program Director for the Department of Emergency Medicine at Baylor College of Medicine. She is one of the founding members of her department’s group FEM@BCM. Dr. Andrabi has three children, ages 6, 5 and two months.