Physicians as parents: How can one pour from an empty cup?

A medical student once told Nikki Lee, RN, BSN, MS, Mother of 2, IBCLC,RLC, CCE, CIMI, CST (cert.appl.), ANLC, RYT500  about an obstetrician who loved to pump while she was catching babies because she collected more milk than usual. Lee theorizes that perhaps it was due to the high levels of oxytocin in the atmosphere during childbirth. 

It’s a fascinating concept, and quite unusual considering physicians often find themselves in a terrible paradox. As Lee puts it, they are supposed to take care of everybody else, and no one takes care of them. They’re expected to be experts on everything;  as childbirth educators and lactation care providers, we often disclaim “this information is not meant as a substitute for medical advice.”

In this two-part series, Lee and I set out to explore the forces that surround infant feeding, ones that physicians must muscle through as parents themselves and as professionals. We explore emerging themes inspired by the article Medical training taught this Philadelphia doctor about breast feeding. But the real lessons came from her twins. In Part One, we offer thoughts on physicians functioning as parents themselves. Part Two covers physicians as professionals trying to support breastfeeding most often with inadequate education and training.

Source: United States Breastfeeding Committee

With insufficient support in their personal infant feeding goals, physicians’ struggles sometimes seem to spur advocacy and a “do-better-for-my patients” attitude. Just the same, these experiences can lead individuals to harbor resentment, despair, resignation and defeat, and might unintentionally influence the breastfeeding support they are able to offer their patients. 

When physicians’ basic needs aren’t met, we can’t expect them to meet the needs of their patients. How can one pour from an empty cup?  Kathleen Kendall Tackett offers Burnout, Compassion Fatigue, and Self Care for Members of the Perinatal Team which presents insights on the effects of little institutional support and specific strategies for integrating self-care into care for others. 

Self-care is sustainable only when everyone can do it. 

Before physicians are done with their decade or more of training, they are challenged by inadequate support in their efforts to feed their own children. 

“In a survey of 412 medical trainees with children, more than 80% of women reported feeling stressed about breastfeeding, and one-third did not meet their breastfeeding goal,” Gaelen Dwyer points out in Pumping up support: Making breastfeeding easier for med students

What’s more, a  recent research letter, American Board of Medical Specialties Board Examination Lactation Accommodation, evaluates the American Board of Medical Specialties (ABMS) member boards’ lactation-specific board examination accommodation policies highlighting that a minority of female physicians (42%) achieve the recommendation that infants receive mother’s milk at least until age one. 

Source: United States Breastfeeding Committee

“Board examinations are a key aspect of medical training,” the authors begin. “With up to 22% of female trainees delivering a child during postgraduate training, and nearly 59, 000 female physicians in residency and fellowship in the US, there is a large group potentially affected by board examination lactation accommodations.”

About a decade ago, ​​in a landmark case that has implications for all testing organizations in Massachusetts, a unanimous Massachusetts Supreme Judicial Court ruled that breastfeeding mothers are entitled to special accommodations to allow them sufficient time to pump milk during lengthy testing for medical licensure. [https://www.wbur.org/news/2012/04/13/breastfeeding-doctor-ruling ] 

The elephant in the room is the issue of parental leave. Honestly, it’s hard to stomach that we are still arguing that there are medical and psychosocial benefits of protected parental leave for both parents and children. The U.S. is the only Organisation for Economic Co-operation and Development (OECD) member country—and one of only six countries in the world—without a national paid parental leave policy. The U.S. is also one of the few high-income countries without a national family caregiving or medical leave policy. [https://bipartisanpolicy.org/explainer/paid-family-leave-across-oecd-countries/

Women don’t breastfeed; societies do. The societal burden on the mother is magnified when the mother is a physician and is compelled to take care of everyone else, with no support for their own breastfeeding. Breastfeeding is blamed for being difficult, instead of us all getting furious that we don’t have paid maternity leave.

In the current U.S. healthcare system, physicians find themselves paid in Relative Value Units (RVUs), which bluntly put, is a pretty mechanical way to value providing care to other humans. In short, the more RVUs a physician racks up, the more they’re paid. Often that leaves lactating physicians forgoing pumping to spend more time with patients. The Providing Urgent Maternal Protections (PUMP) for Nursing Mothers Act would close the loopholes that force physicians to choose income or feeding their babies. The PUMP Act advanced out of the Senate HELP Committee with unanimous bipartisan support in May 2021 and then passed with significant bipartisan support (267-149) in the House last October. Despite this strong bipartisan support, the bill has languished in the Senate for almost a year. Get updates on progress here

In February 2021, the American Academy of Pediatrics (AAP) issued a policy statement on Parental Leave for Residents and Pediatric Training Programs.

Source: United States Breastfeeding Committee

The policy reports that the Institutional Requirements of the Accreditation Council for Graduate Medical Education require training programs to provide written policies regarding leaves of absence, including parental leave, and these policies must comply with current legislation such as the Family Medical Leave Act (FMLA), but that the length of leave has considerable variability among residency programs. The statement outlines the challenges of parental leave policies in training programs and gives recommendations to protect trainees and their families. One challenge is that education calendars are set long before a person enters a medical program, but labor, delivery, and the establishment of breastfeeding don’t fit into a predetermined calendar. 

Despite this dismal landscape, the medical world is changing and there are stories and models to celebrate. 

Catherine Wagner, a cardiothoracic surgery resident at Michigan Medicine, managed to breastfeed and pump for a year during her residency with a network of support. 

A committee at the University of Michigan is calling on pediatricians to support their fellow physicians.  Pediatricians Advocating Breastfeeding: Let’s Start with Supporting our Fellow Pediatricians First describes the efforts to support lactation within the department. The committee collected university policies, state and federal laws, identified the needs of breastfeeding mothers and then created a policy to support lactating individuals as well as a handout to help supervisors and colleagues support lactating women in the healthcare setting. (Supplemental material; available at www.jpeds.com).

Got Milk? Design and Implementation of a Lactation Support Program for Surgeons describes an initiative where “Multiple faculty members offered to offload resident workload before starting cases to provide time for a lactating resident to express milk… The University of Wisconsin adopted a ‘cross-cover’ model encouraging lactating residents to have other residents assist in the operating room during non-critical portions of the case if the primary operating resident needed to express milk that has been very well received and easily implemented.”

Source: United States Breastfeeding Committee

There’s attention being paid to lactation accommodation information in urology residency programs too. 

In this study, “Of 145 urology residency programs, 72.4% included information about lactation accommodations anywhere on the institution’s website.” The authors conclude that “efforts to recruit and retain female urologists should include making [lactation accommodation]  information more easily accessible.”

Authors Annery G Garcia-Marcinkiewicz and Sarah S Titler call on  anesthesiology as a workforce and specialty, to support the unique need of lactating and breastfeeding anesthesiologists in Lactation and Anesthesiology

This study offers the first comprehensive scoping review of the literature on breastfeeding policies pertaining to surgical residents in Canada.

The authors write: “…We aim to use these data to advocate for breast feeding for surgical resident physicians through the creation and improvement of current breastfeeding policies as applicable. This work aims to help change surgical culture to be more inclusive, which is vital in creating a breast feeding-friendly environment. This would include leadership endorsement of the policy, a culture shift (for example, no repercussions to resident for coming back on a modified schedule or taking breaks for expressing milk), visible educational notices throughout the workplace (ie, ‘breast feeding-friendly workplace’ notices, common in Canadian public settings), and creation of a network of ‘new moms’ within the surgical resident programme to ensure there is support and mentorship for new moms returning back to work. ”

While we wait for policies to catch up to the needs of lactating physicians, wearable pumps are helping them reach their infant feeding goals.  The Impact of Wearable Breast Pumps on Physicians’ Breastfeeding Experience and Success found that “those who had used a wearable pump reported statistically significant shorter lactation breaks (p < 0.00001) and were more likely to be able to provide breast milk to their infants for their entire intended duration (p = 0.005) compared to the traditional pump group.” 

The support network Dr. MILK (Mothers Interested in Lactation Knowledge) has been successful at helping physicians mothers reach their infant feeding goals. 

Where else are you seeing physician parents being supported in their infant feeding journeys? Email us at info@ourmilkyway.org

Revive. Restore. Reclaim. Happy Black Breastfeeding Week!

 The final week of National Breastfeeding Month is upon us, closing out strong with Black Breastfeeding Week: Revive. Restore. Reclaim (August 25-31). 

During Black History Month, Nichelle Clark of SonShine & Rainbows Lactation wrote in her piece Breastfeeding As An Act Of Resistance For The Black Mother

“Black History Month in the breastfeeding community is normally littered with posts and articles about the dark history of African American Breastfeeding in this country. I firmly believe that in order to understand where you are going, you must first understand where you have been. However, Black Mothers in today’s society face a very different dilemma: actually being Black History.” 

Joy R. Gibson, MSEd is an early childhood educator and advocate and the mother of five, ranging from age 18 months to 13 years. She gave unmedicated birth to all five of her children in Pittsburg, Pa.,  practiced the Lamaze method, and talked to her babies as she labored with them. 

Joy R. Gibson, MSEd

“We can’t wait to see you,” she gently called. 

Gibson went on to breastfeed all of her children until they self-weaned. 

“I think [breastfeeding was] best for my babies, and I love the bond that it creates. I love when it gets to be that one-on-one time to focus on the child,” Gibson shares. 

She goes on to share that early on, she and her first child struggled to find a comfortable latch. After visiting with a hospital-based lactation care provider, Gibson and her baby were able to work through the challenges. Beyond that, she recalls her babies not appreciating being covered in public while they nursed, which felt more like an inconvenience than a challenge, she describes. 

Gibson felt supported through her breastfeeding journey. 

“Always from family and friends and even from my job when I had to pump,” Gibson says. 

While working in a child care center, Gibson would feed her baby who was also at the center and then return to work. 

Having felt empowered through her birth and infant feeding experience, Gibson says she wants to become more involved in maternal child health advocacy and connect with other mothers through their challenges and triumphs. She is currently involved with Healthy Start, Inc. Pittsburgh/Allegheny County’s Community Health Advocate Training Program where she will be able to exercise her passion and help improve the health outcomes of other mothers in her community. 

The Gibson family.

Gibson is Black History.  Gibson is #ReviveRestoreReclaim.

How will you #ReviveRestoreReclaim Black breastfeeding in 2020? Join the #BBW20 movement and follow @BlkBfingWeek.

USBC also calls upon us to:

  • Raise your voice for breastfeeding families and take action with @USBreastfeeding in support of the MOMMA’s Act! Learn more about the bill:  https://bit.ly/2CUOmE9 #NBM20 #ManyVoicesUnited
  • @USBreastfeeding is launching another free webcast session this week! Learn about the presentations in “Optimizing Support for All Populations” https://bit.ly/NBCCReimagined #NBM20

How to support world’s coordinating authority in setting global health norms

I have a friend who describes her experience wading through the pandemic as paralyzing. 

Photo by The New York Public Library on Unsplash

In the first few weeks of the social distancing orders, she says she found herself just standing there at times, staring off into the distance with an utter sense of loss. 

It’s a familiar feeling. Even with so much to be grateful for, there’s static that surrounds us– a heaviness that lingers around the edges, as my friend puts it. 

“It’s a pretty big presence to try to push away with positivity right now,” she counseled me. 

Amidst the stillness, what sometimes feels like paralyzation, there are actions taken, decisions made– like President Trump’s decision to halt funding to the World Health Organization (WHO) during a global pandemic— with sweeping consequences. 

Trump’s plan to defund WHO has been met with mobilization by the International Baby Food Action Network (IBFAN) and partner civil society organizations who are  joining forces to support WHO. You can read IBFAN’s full statement of support to WHO from April 11 here

Patti Rundall is the Policy Director Baby Milk Action, Global Advocacy IBFAN.  

“We have been one of the most outspoken NGOs, calling for WHO to adopt a sound conflict of interest policy to safeguard its independence and resist the unjustified influence of powerful interests, be they commercial or political,” she writes in an email to Our Milky Way.  “…All our criticisms are focused on supporting WHO in its unique role as the world’s coordinating authority in setting global health norms.” 

Specifically, WHO “is absolutely critical to the world’s efforts to win the war against COVID-19,” as U.N. Secretary-General António Guterres declares in a UN News story

Guterres goes on to say in that piece that it is “not the time to reduce the resources for the operations of the World Health Organization or any other humanitarian organization in the fight against the virus.”

Bill Gates on Twitter writes: “Halting funding for the World Health Organization during a world health crisis is as dangerous as it sounds. Their work is slowing the spread of COVID-19 and if that work is stopped no other organization can replace them. The world needs @WHO now more than ever.” The Bill & Melinda Gates Foundation’s voluntary contribution to WHO is second to the U.S.’s assessed and voluntary contributions. [More here.] 

Rundall adds: “WHO is needed to guide not only country responses to COVID-19 but also the host of other global threats that we face – not least global heating, new viruses, antimicrobial resistance and non-communicable diseases.” 

Rundall explains that “the U.S. is not the only nation to lobby against the much needed increases of Member States assessed contributions, but it is one of the most powerful.”

“For goodness sake, WHO’s total annual budget of $2.5bn is about the same as the budget of a large US hospital,” she puts the money into perspective.  

Even without defunding, WHO is already underfunded

Even as many of us are feeling debilitated to some degree, Rundall offers suggestions on how to take action for good. 

“We hope that US citizens– and especially anyone working in infant and young child health– will remember the critically important role that WHO has had in child survival,” she begins. “and do everything they can: write to politicians, media, social media, friends  and distance themselves from President Trump’s statements about health.”  [Link added.] 

Rundall directs us to the Society for International Development’s stance on Trump’s move which reiterates the G2H2 statement as well as an open letter of support to WHO and Dr. Tedros Adhanom Gebrheyesus in BMJ

Visit Rundall’s frequently updated policy blog here

Never underestimate a mother

This photograph brings the kind of smile to my face that lifts my ears up several millimeters and presses the tops of my cheeks into my bottom lashes. The athletes are so expressive, I almost squeal in excitement as if I’ve just witnessed their victory. 

The story behind the photo is summarized by Ann-Derrick Gaillot in 10 Women’s Sports Stories That Would Make Great Films:

“When the winners of the women’s 4x100m relay at the 1992 Summer Olympics in Barcelona were announced, no one was more thrilled to win than the bronze medalist team from Nigeria. Teammates Beatrice Utondu, Christy Opara-Thompson, Mary Onyali, and Faith Idehen were relative outsiders in the international running scene and were not expected to stack up against powerhouses like France and the United States. Though injury and traditional cultural gender norms would threaten their chances of competing in those Olympics at all, they would leave Barcelona that summer as the first Nigerian women to win Olympic medals. Onyali eventually went on to become one of Nigeria’s most successful runners, appearing at the Olympics four more times.”  

Underdog stories are always inspiring, and they’re happening every day when a woman becomes a mother. 

That’s Nurse-Family Partnership supervisor in Buffalo, N.Y. Daynell Rowell-Stephens’s MS, RN message.

“Stay open no matter what the circumstances the mother may be going through,” Rowell-Stephens offers. “[Mothers] have the ability and the capability to be the best moms, to flourish. Never underestimate a mother because motherhood drives women to be the best.”

Photo by Sai De Silva on Unsplash

She continues, “Support moms no matter what; whether it’s drug use or homelessness– I’ve seen it– motherhood really launches them into directions they never imagined they could go into.” 

Rowell-Stephens and her colleague’s agency is just over a year old, and in that short time, they’ve managed to make a great impact on the lives of mothers and their new families. 

“We are so excited about all that we are doing,” Rowell-Stephens says. 

It’s well-documented that people of color have less access to health care resources and are faced with structural barriers that inhibit good health outcomes. Amani Echols points out some of those barriers in The Challenges of Breastfeeding as a Black Person:

  • “Many Black people work, and breastfeeding at work is hard…
  • Black neighborhoods are also lacking in hospital practices supporting breastfeeding…
  • The societal stigma of breastfeeding is heightened for Black and brown people.” 

These are big gaps to fill, but Rowell-Stephens and her team readily take on the challenge.

They make sure their clients receive proper prenatal care by connecting them with various health care providers including midwives and doulas. They provide nutrition counseling. They help them secure housing and jobs and continued education. They impact decisions about cigarette and drug use. They support them through mental health crises. They educate on how to navigate different stressors. They support healthy infant feeding and bonding.

“All of the nurses on the team are very passionate about breastfeeding  so we love to see so many of our moms interested in learning to be successful at breastfeeding,” Rowell-Stephens comments. 

She’s the most recent member on her team to complete the Lactation Counselor Training Course (LCTC). She says the experience was “quite eye-opening.” 

“It is really going to change my practice overall,” she says. 

Maybe most importantly, the team teaches their clients how to healthfully engage with their children. 

“It makes me so excited to see these girls change their whole outlook on life,” Rowell-Stephens says of her clients when they become mothers. 

She celebrates the story of one of her clients who set a personal goal to complete a rehabilitation program and acquire a living place before the birth of her baby. 

“She accomplished that!” Rowell-Stephens reports.

Not long after, the mother’s roommate was using drugs in the home. 

“Her motherly instinct kicked in and she knew she needed to get out of that environment,” Rowell-Stephens begins. “She recently found another apartment and she’s providing for her child.”

Rowell-Stephens goes on, “She’s taken what might seem like very small steps, but for her, as we look back at just this past 9 months, she has done so many things. She has changed the world around her.”