This is the third in a work/life balance series written by members of the STFM Group on Women in Family Medicine.
Returning to work after the birth of a baby challenges all mothers, regardless of the age of the child. However, for breast-feeding mothers, there are special considerations.
Compared with 25 years ago, we’ve made substantial progress in returning to breast-feeding as the best method of infant nutrition. The World Health Organization Guidelines of exclusive breast-feeding for 6 months, followed by weaning foods and continued breast-feeding until 2 years, are widely promulgated by us in family medicine.
Many women faculty with a young infant have struggled with how to operationalize continued breast-feeding after returning to work. Expressing milk is thought to be a routine expectation for workplace mothers, but the actual lived experience of this proves challenging and may not be discussed in professional circles.
Personally, I have been committed to the idea of breast-feeding since college, when I learned about the global marketing practices of Nestle for infant formula throughout the world, in contrast with the emerging body of evidence of the biologic superiority of human milk. When I was pregnant, the necessity of breast-feeding became personal, not just academic. So, in the ironic way of physicians who “know too much,” I wound up with an insufficient milk supply. When I first returned, colleagues welcomed me back, and when they inquired about the breast-feeding and I disclosed the problem, they responded, “Just nurse more!” I didn’t find this particularly helpful, as I had already gone through an extensive evaluation and had learned that my physiological problem wouldn’t respond to the traditional advice about increasing milk supply. (See recent coverage about lactational insufficiency.) Notwithstanding that, I stubbornly pumped the tiny of bit of milk I did have. I knew my son was growing on formula and clung to the notion that I could give him tidbits of immunologic goodness.
Having my own office greatly facilitated pumping, and the fact that I only pumped once or twice per day interfered very little with my schedule. For my second child, I experienced similar lactation insufficiency and decided to discontinue expressing milk while at work much earlier than I had with my first. It was almost a relief, after I’d gotten over the guilt of the inadequacy.
As junior faculty, I was having my children at the same time as several of my residents and other colleagues. This was before hospitals and other workplaces were being called on to provide breast-feeding facilities for their staff. I remember feeling grateful for the privacy of my office and witnessed residents scrambling to find a place to pump. I hung a “breastfeeding friendly” logo on my door and asked the staff to unlock my office for residents in need of a safe, clean, private pumping place.
Shortly after I relocated to another academic position, at 60% of full-time, I became pregnant with my third child. As a known “lactation failure” I figured I wouldn’t even bother with breast-feeding on the third go-round. A wise and wonderful lactation consultant encouraged me to give it a try anyway, and by the second week I somehow had plenty of milk for my daughter. So this time, returning to work necessitated me really figuring out how to integrate milk expression into my day. I practiced at a crowded inner-city health center with longstanding colleagues with whom I had trained. The office was always crowded, had only one small “single seat” staff bathroom, and all the clinician offices were shared. Sometimes I’d go in a patient room to pump. A particularly harried moment occurred one day where there was literally no place to go. I went into the shared clinician office where two of my longstanding female colleagues were working, and explained the situation, ending with, “Do you mind if I pump?” “No, go ahead,” they responded and continued on with their administrative work. No movement. I’d thought they might step out for 10 minutes, but since I hadn’t asked it seemed too late. So, pump I did: in front of women colleagues, who seemed unperturbed by the situation!
Like other colleagues, I was constantly trying to figure out how to sandwich in pumping, especially into the clinical schedule. Typically in clinical practice, I could never justify taking a break for myself, even to go to the bathroom. I didn’t want to make my patients wait any more than they already did. Even blocking out a patient appointment, it seemed that phone calls, or some other clinical exigency would wipe out that time so that I was running to catch up or not fall further behind.
My lactation days are far behind me now, but I remember them as challenging and wonderful. I found it a particularly vulnerable time, dealing with issues of adequacy as a mother to a dependent being and figuring out how to stay professionally engaged and competent. Adding breast-feeding to the equation is one more piece of the puzzle, as adequacy of infant feeding and growth is often attributed to the mother’s skills, and certainly pumping milk while away from home can be challenging to integrate into an already demanding faculty schedule.
In family medicine, we must address the needs of our colleagues who are balancing the demands of a mothering a young infant, breast-feeding, and maintaining their professional role. Without being intrusive, we can gently check in with junior colleagues about their balance and any challenges for which they might like support. It’s as important not to assume: don’t assume everything is as smooth as it might look, or conversely, is as difficult as it might be. Many women will want to talk about challenges and perhaps share funny or awkward stories; others will prefer to maintain more privacy about their personal boundaries of mothering and professional life.
Either way, we as a community of educators should support breast-feeding and mothering as an important part of the work done by our colleagues.