June 26, 2019 02:35 pm Chris Crawford – Despite being educated about the benefits of breastfeeding and taught to encourage and support their patients in their breastfeeding efforts, medical trainees may struggle in their own efforts to breastfeed.
"Medical trainees who are breastfeeding do not always receive adequate support from their colleagues and institutions," said Scott Hartman, M.D., of Rochester, N.Y., the current AAFP liaison to the U.S. Breastfeeding Committee and an avid breastfeeding advocate on multiple hospital breastfeeding and neonatal care committees.
Additionally, Hartman told AAFP News that medical trainees' long hours and patient care demands can make their continued breastfeeding challenging.
This issue led the AAFP to update its policy supporting breastfeeding and lactation accommodations for medical trainees, a process Hartman was involved in.
As that process was unfolding, the American Academy of Pediatrics Project Advisory Committee asked the AAFP to take the lead on a CDC grant to develop a model policy in support of breastfeeding medical students, residents and fellows that aligned with the goals of the AAP's Physician Education and Training on Breastfeeding Action Plan.
The AAFP has updated its policy supporting breastfeeding and lactation accommodations for medical trainees, which other medical organizations plan to use as model policy for their members.
Key elements of the policy include providing adequate lactation facilities and protected time for expression of breast milk or breastfeeding, as well as outlining roles and responsibilities to provide an environment of support for breastfeeding trainees.
According to current AAFP liaison to the U.S. Breastfeeding Committee Scott Hartman, M.D., of Rochester, N.Y., the Academy's new policy on lactation support for medical trainees reinforces its focus on health equity and public health promotion for all.
Approved by the AAFP Board of Directors this month, the new Academy policy states, "it is essential that medical educators, including medical schools, residency and fellowship programs, and health care facilities, establish an environment that provides encouragement and resources for the successful continuation of breastfeeding."
"Programs with family-friendly policies, including lactation support, may be better able to recruit and retain residents, fellows and young faculty physicians," notes the policy statement, which aims to help medical schools, residency and fellowship programs, clinics, hospitals, and health care systems develop policies that support the needs of their breastfeeding medical trainees.
Accommodations for breastfeeding among such facilities are highly variable, said Hartman. "Institutions developing a lactation policy should adapt and modify the key points provided as appropriate for their setting and resources. Key items needed include adequate lactation facilities, protected time for expression of breast milk or breastfeeding, and policies outlining roles and responsibilities to provide an environment of support for breastfeeding trainees."
It should be noted that the Accreditation Council for Graduate Medical Education lists the provision of lactation facilities, separate storage for breast milk and protected time in its common program requirements for residency training programs.
The AAFP, AAP, American College of Obstetricians and Gynecologists and the World Health Organization all recommend infants exclusively receive breast milk for their first six months of life, with continued breastfeeding for at least the first year and beyond.
"Breastfeeding is the gold standard for maternal-child health and is associated with significantly reduced rates of many acute and chronic illnesses for birthing persons and their children," Hartman said.
Breastfed infants have reduced risks for several childhood illnesses, including ear and respiratory infections, allergies, asthma and obesity, says the policy. Breastfeeding also is associated with a lower risk of sudden infant death syndrome.
In addition, women who breastfeed have lower risks for breast and ovarian cancer, type 2 diabetes, and hypertension.
Businesses and institutions benefit when their employees breastfeed, Hartman said. Successful breastfeeding results in lower medical costs for employees and their infants, less absenteeism, reduced turnover rates, higher productivity, and greater employee satisfaction.
"However, many women stop breastfeeding early due to lack of institutional support," Hartman said. "Working outside the home is associated with shortened duration of breastfeeding, and conditions in the workplace further impact this duration."
Specific sections of the policy address lactation facilities, protected time, a culture of support and responsibilities.
First, training facilities should provide designated lactation rooms for medical trainees, which should be close to trainees' work/study area and separate from lactation rooms for patients/hospital guests.
"The number of lactation rooms needed depends on the size of the facility, with the rule of thumb being that one space for milk expression is needed for every 50-100 female employees ages 18-45," Hartman said, adding that this number will vary based on a number of factors.
The minimum requirements for lactation rooms are
As for protected time, medical trainees will need to express breast milk every two to three hours.
"The trainee will need 20-30 minutes, depending on the proximity of the lactation space, the quality of breast pump, access to pump and storage, and individual variations in time needed to express sufficient milk," Hartman said.
Due to medical trainees' demanding schedules, which frequently involve patient care responsibilities, finding protected time to express breast milk requires support from faculty, colleagues, staff and administration, the policy states.
Furthermore, says the policy, break times may need to be scheduled in advance to ensure appropriate coverage of patient care responsibilities. "In these cases, the trainee should work with their supervisor to determine an appropriate schedule and arrange for patient care coverage," it notes.
To create a culture that supports the needs of breastfeeding women, all employees must be regularly educated about the benefits of breastfeeding, the details of the lactation policy and their responsibilities as outlined by the policy.
"Ways to disseminate this information may include training and materials provided during new staff orientation, yearly training programs for managers/supervisors, promoting it on the institution's website and including it under the benefits program," the Academy policy suggests. "The policy should be included in any informational packets provided to pregnant trainees."
In addition, institutions should publicize the fact that lactation rooms are available to medical trainees, listing locations and who to contact for more information.
Finally, facility policies on breastfeeding and lactation should clearly outline roles and responsibilities of administration, supervisors and trainees.
Facilities should identify a specific policy administrator, with this person being responsible for ensuring regular education about and promotion of the policy. The individual in this role also is responsible for conducting or delegating training and for ensuring that lactation rooms and equipment are properly maintained. Finally, this person should develop and implement a clear process for receiving complaints and documented action plans to address those complaints.
Supervisors (program director/department chair) are responsible for being aware of and supporting the lactation policy, as well as for informing pregnant and lactating trainees about their options for expressing breastmilk.
"Supervisors should work with the trainee to determine an appropriate lactation schedule," the policy said. "The supervisor should communicate with others, especially faculty, who will be affected by this schedule. The supervisor should communicate clear support for the trainee and ensure that there is a plan for patient care coverage."
Trainees' role in this process begins by informing their supervisor that they require accommodations to express breastmilk.
"Ideally, this will occur during her pregnancy, prior to maternity leave," the policy notes. "The trainee and their supervisor should work together to determine a schedule that meets the trainee's lactation needs while maintaining patient care responsibilities and/or classroom requirements."
Lastly, when using the lactation space, trainees should clean up after each session and report any issues with the facilities to the appropriate person.
According to Hartman, the AAFP's new policy on lactation support for medical trainees reinforces its focus on health equity and public health promotion for all.
"The Academy has been a leader in breastfeeding medicine but needs to assure that it also protects the rights and needs of medical trainees. This new policy serves as an excellent step in that direction," he concluded.