by: Samantha J. Baker
I am a PGY-5 General Surgery resident at the University of Alabama at Birmingham and returning from maternity leave for my second child as this blog post is being published. I am currently in the midst of the feeding, pumping, middle of the night do I “wake or pump” mental tango, and planning logistics about how to return to work mayhem. I had my first child as a third-year resident and was fortunate to pump for a year. At that time I leaned on friends, family, and colleagues to figure out how to continue to provide breast milk as a resident. To be honest, when I started out I felt like I had no idea what I was doing. I hope that this blog post will help anyone who is looking for somewhere to start or maybe plan for the future. I am by no means an expert. A year is a lot of time to invest in something and I am about to embark on that journey again.
I will start with the most important point in my mind- Fed is best. Period. Whatever that looks like. There is so much pressure on women to breastfeed (and a lot of mom shaming). Before my first child , at every prenatal appointment, I was asked “are you going to breastfeed?” I would reply, “I am going to try,” which I felt- as a surgery resident- was the realistic response. You need to do whatever is best for you and your baby. Which brings me to the guiding principle (words from a very wise attending) that I used last time and will definitely be repeating in the coming weeks, do it until it doesn’t make sense anymore. If it doesn’t make sense for you, for your child, for your timing, your mental health, your sleep, whatever– then give yourself permission to stop.
I want to recognize my bias upfront. I chose early on to exclusively pump. My baby and I were not great at breastfeeding, and it did not come or feel natural to me/us. I had never planned to go over a year and was willing to stop earlier. Some people breastfeed for the bonding connection and a whole other host of reasons, so these tips might not be the most helpful if you are looking for an exclusively breastfeeding relationship, mixed pumping/breastfeeding relationship, or for it to last longer than a year.
Tips (not an exhaustive list and I apologize if it seems disjointed; I’ve been writing down my thoughts between feedings and unfortunately short naps):
- Find a group either local or on-line. At the very least it can act as a sounding board to help troubleshoot schedules, what to pack, what pump to buy, etc. I joined a Facebook group called Dr. Milk which is a physician’s group that requires an invitation and an NPI number to join. It was very helpful to read the group especially during middle of the night feeds or pumping sessions. They have posts about moving your freezer stash when starting a new job/fellowship, storing milk while at conferences and traveling, what medications are safe to take, and how to troubleshoot your pump- just to name a few.
- Find out if your program has any policies or procedures in place to help pumping at work. If your program does not have a lactation policy, you can find information about implementing lactation policies by the General Surgery Program at the University of Michigan.
- Reach out to attendings or other residents who may have pumped at work for support.
- Lactation consultants are great resources while inpatient. Once back at work, if you forget a pump part or are having issues, they usually have an office somewhere and may be able to give you spare parts (I forgot bottles once and tried to use specimen cups. It did not work. I walked over to their office, and they gave me bottles to pump with). If you deliver at the hospital where you are employed, ask the in-hospital lactation consultant for a set of hospital compatible pump parts. I kept them in my locker at work. I had to use them once when my portable pump broke and then a second time to replace some tubing. I always felt more comfortable knowing I had a backup plan at work.
- Lactation rooms. Does your hospital have these? It is an ACGME requirement that residents have access to a space for lactation. The lactation spaces at UAB are nowhere near the OR (something our housestaff council is working on), so there are other designated spaces (workrooms with a sign, faculty offices, staff may close down a clinic room). I got a portable pump and pumped everywhere (running traumas, placing chest tubes, rounding, in clinic) and was less reliant on a room. But portable pumps do not work for everyone, and they can break, so it is good to know where you can sit and pump if needed.
- Where will you store the milk once you pump it? Some people have access to a fridge in someone’s office or workroom. If not, there are chillers you can buy that will keep milk cold all day when you do not have access to a fridge.
- Buy 2 sets of pump parts for both your standard pump and portable pump, trust me. That way if it is a really long day you can skip washing the pump parts or put them in the dishwasher for the next day because you have a second set that is already clean.
- Get a Wet bag. There is no need to wash parts between use at work (in general, for term healthy kids). Instead throw the pump parts into a wet bag and put them in the fridge. Will save tons of time and need for counterspace/place to wash parts.
- Pump bag, ice packs. There are a few bags marketed specifically for pumps that can be found online, and some are really fancy and pricey. You can also just use a large insulated lunch kit from Amazonas a dedicated bag to hold all of your stuff. Also, if you will have limited access to a refrigerator, then you will want something insulated, like a separate small bag with an ice pack for storage or one of the large chillers.
- Your flange size may change. If you notice your output has decreased or pumping is no longer comfortable then it may be time to re-measure and resize.
- Pump between each case, no matter the turnover time. This is some of the best advice I was given. On OR days I pumped between every case regardless of the interval. It is best to start a case empty. If the case is running long, then wait until a non-critical portion and ask to step out for a bit to pump. The key here is communication. It is possible to be a lactating/pumping resident and have effective, meaningful time in the OR.
- Going back to work and need a small freezer stash? If your output allows, consider adding a pump session following a morning feed for the week or two before your return to work. This can help create a small surplus you can freeze. This milk can then be used for that first day you are back at work before you are able to bring pumped milk home for the next day. Freeze in small (3 oz or less) amounts, lying flat, with as little air in the bag to facilitate defrosting.
- If you have a portable pump you are going to use at work, start using the portable pump at home the week before you go back to work. These pumps have a learning curve and you want to have an idea of how to use them before you start pumping between cases. I realized I needed to bring something to set up the pumps on so they would not touch the workroom counters. You will also learn if the pump does not work for you and if you need to come up with another plan.
- There are lots of great pumps out there. I recommend that you do your own research to try to find the right one for you. If you have done all the research and still do not know where to start, I would consider getting the pump that one of your friends has. That way you have someone you can go to if you have questions or need to troubleshoot the pump.
- Have a partner that wants to help? It is incredibly helpful and uplifting to have your partner wash the pump parts at the end of the day. After working 14+ hours and pumping every 3-4 hours all day, the last thing you want to do is wash the parts for the next day.
- Some programs have education stipends that can be used to purchase portable pumps instead of books or question banks, etc.
- Communication: You should feel empowered to speak up for yourself and ask to step out, but that isn’t always the case. Some programs have a policy where the Program Director reaches out to the rotation faculty prior to the resident starting that rotation. The PD lets them know that there is a lactating resident joining the service and to expect them to step out of the OR to pump. Think about how you will handle this before you are in that situation when you cannot wait any longer and need to step out. Ask around for advice if needed or seek out an advocate to help set you up for success.
I was able to pump for an entire year last time. What will happen with this child… unknown. I will try to do that again but am willing to stop earlier if/when it doesn’t make sense to continue. I may try to breastfeed when at home and pump at work instead of exclusively pumping (so many fewer things to wash and drag around when getting out of the house, but we will see). I may try to create a large enough freezer stash that I do not have to pump as often as a trauma fellow next year. It is hard to predict what will happen. I would be remiss if I did not take some time to say thanks to my husband, friends, co-residents, program and program leadership for the support. It really does take a village and I was only successful because I had so many people who were willing and able to work with me to figure it out.
Breastfeeding/pumping is hard; let’s be honest: being a surgery resident is hard, and being a new mom on top of that is a lot. Hope this blog helps and if you find yourself somewhere where you do not feel supported, consider broadening your search. There is a community out there. Through social media (Facebook, Twitter) we can support each other and try to make the transition back to work easier if possible. Please feel free to reach out to me with any questions. Like I said, I am not an expert but I am willing to share what I did, what supplies I bought, schedule I followed, etc. in case it helps someone else.
Samantha Baker is a General Surgery Chief Resident at the University of Alabama at Birmingham. During her residency training, she undertook dedicated research time studying surgical education and health literacy. She was able to obtain an additional degree from MGH in Surgical Education and is currently pursuing a PhD. She has two daughters that were both born during her clinical years as a Surgery resident (PGY-3 baby is 2 years old and PGY-5 baby is almost 6 weeks). She is excited to move back to her hometown, New Orleans, next year as the Trauma, Critical Care fellow at Louisiana State University.