Introduction

More women are entering medical training, and interest in family integration and childbearing is increasing.^1–9 Many residents extend maternity leave, citing the desire to breastfeed as a reason.⁶

Continuing breastfeeding after returning to work is challenging, and research has demonstrated shorter maternity leave is associated with early breastfeeding cessation,¹⁰ and that half of residents discontinued breastfeeding when they returned to residency.¹¹ Recent surveys confirm that lactation barriers remain across specialties.^6,12–14 Studies have reported methods to improve lactation efficiency in mothers of neonatal intensive care unit (ICU) infants,^15–17 but none have examined lactation in resident physicians after return from maternity leave.

In this single institution pilot study, we sought to improve resident lactation by comparing high-tech, hospital-grade pump (HGP) use to that of a portable double electric pump (PP).

Methods

Six women in a pediatrics residency at a tertiary hospital were recruited from a group of 7 residents who were breastfeeding (in a program with 40 residents).

Results

Participants were at various levels of training, postgraduate year 1 (PGY-1) to PGY-4, including 3 residents in their final year of training (table). Most (83%, 5 of 6) were first-time mothers. Average maternity leave duration was 8 weeks (range, 6–12 weeks). All residents had their own PP, which they had experienced using before returning to work. Of the 4 residents who weaned during the study period, the average duration of breastfeeding was 11.7 months (range, 8–14 months).

table Characteristics of Resident Participants (N = 6)

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Mean lactation time with PP was 24 minutes (range, 15–40 minutes), compared with 15.5 minutes with HGP (range, 10–32 minutes), resulting in a significantly decreased average lactation time of 8.5 minutes using the HGP (95% confidence interval 3.8–12.2, P = .045). Mean production volume increased from 6 ounces (range, 3.5–8.5 ounces) with PP to 8.8 ounces (range, 8–11 ounces) with HGP, for an average increase of 2.8 ounces (95% confidence interval 1.2–4.3, P = .06). The data were analyzed and found to have normal distribution.

The most common responses to the open-ended study questions were improved ability to stay in touch with active patient care (6 of 6, including less time missed from rounds, able to stay in communication while pumping, able to monitor test results), greater ability for task completion (6 of 6, including note completion, lecture attendance, study time, research completion), increased comfort (5 of 6, including less irritation, improved emptying, less concern for leaking after pumping), and reduced anxiety and guilt (comments from peers and faculty, and perceptions about work-life balance).

All participants chose to work while pumping. The quieter nature of the HGP compared with the PP allowed for completion of a wider variety of clinical work because residents felt comfortable completing tasks, such as answering pages and calling families, which previously were postponed when using a louder pump. Many residents also reported letdown was improved due to working instead of relaxing. One resident explained, “If I just sit there, I start to get anxious about all the things I should be doing, and cannot make much milk. Once I start dictating or writing notes I can let down much easier as I'm less anxious I'll get behind.” Another resident explained, “I don't want to miss good conferences, and with a limited window to pump and attend conferences, I used to skimp on pumping, but now appreciate I am able to do both.”

Discussion

Providing residents with an HGP and necessary equipment increased their availability for education and service. All participants decreased lactation time while increasing production volume. With extrapolation of our data, a resident working a 16-hour shift would save an average of 34 minutes over the course of the day, and a resident on a 24 + 4–hour call would save 60 to 90 minutes. Another positive effect of the designated lactation space was improved productivity. Residents reported that working improved milk output, in contrast to conventional studies suggesting that relaxation maximizes milk letdown.^18,19 This outcome may be unique to medical residents, and may warrant further study.

This study has several limitations. All work was carried out at a single institution and in a single discipline, which limits generalizability. We acknowledge that not all institutions may have resources to replicate the study. In lower-resource settings, having a consistent space and protected time (1 block every 4 hours) is likely most important, followed by availability of an HGP. We were able to justify the modest cost of the HGP by the reduced lactation time and increased clinical productivity.

Conclusion

This study demonstrated that a private space outfitted with an HGP and materials to promote continued clinical and educational tasks for lactating residents resulted in reduced time for pumping, increased volume of milk, ongoing task completion, and high resident satisfaction.