Free Webinar

Learn About Breastfeeding Protections in Clinical Settings

February 06, 2019, 11:55 am Chris Crawford – The AAFP joins 10 other health care organizations in hosting a free webinar Feb. 11 from noon to 1:30 p.m. ET titled "Breastfeeding Works: Legal Protections for Lactating Employees and Students in the Health Care Industry."

Those planning to attend the webinar can submit questions ahead of time so they can be addressed during the presentation.

Family Physician Expert's Thoughts

Anne Montgomery, M.D., M.B.A., of Indian Wells, Calif., told AAFP News that there's clear evidence that exclusive breastfeeding for six months and continued breastfeeding with appropriate complementary foods up to two years leads to the best health outcomes for mothers and babies.

The International Labor Organization says new mothers should receive 16 weeks paid leave, Montgomery said. "And breastfeeding is most likely to be continued if mothers get off to a good start -- 16 weeks together with baby facilitates that," she added.

However, federal law in the United States does not require paid, protected maternity leave. So, many mothers go back to work as soon as two weeks after birth and most mothers return by six weeks, Montgomery said.

"Need to return to work is one of the most common reasons women wean their babies too soon," she said.

But mothers who have good support for breastfeeding at work are most likely to continue breastfeeding. This includes time for feeding or expressing milk, a private place that is not a restroom for expressing/pumping and a place to store expressed milk, Montgomery said.

Federal law does provide some protection for working women -- but only for those with hourly wages, which could include some practice support staff. The protections do not apply to salaried "key" employees, which includes most physicians, or to medical students who are not employed.

Montgomery noted that it's particularly important to provide accommodations for medical students and physicians, since physicians tend to base their breastfeeding counseling on their personal experiences.

"If we want our physicians to support their breastfeeding patients, it's best if they have a good personal experience," she said. "Even if they have challenges, it's good if they are supported in addressing those challenges."

Physician-mothers have many barriers to breastfeeding, Montgomery said.

"For medical students and residents, they have little control over their own schedules," she said. "Medical schools and residency programs may not have facilities to support breastfeeding. It is hard to get time at appropriate intervals to express milk."

On July 1, however, the Accreditation Council for Graduate Medical Education will begin requiring residency programs to have appropriate policies and support for lactating residents. Citations will not apply during the first year of the requirement, giving programs time to make necessary changes.

Even practicing physicians have challenges finding time and space at work to support breastfeeding, Montgomery said. She explained that to optimize breastfeeding, women need to be able to express milk as often as their baby would feed, which is four to six times per day for young babies.

"So, moms need at least morning, afternoon and lunchtime breaks for expressing if they feed or express just before and just after their workday," she said.

When she was working and breastfeeding a young child, Montgomery said she had a 20-minute, mid-morning break for pumping. And because she wasn't allowed to see fewer patients during this time, she came in to work 20 minutes early each day.

But since she was the first one in the office every morning, staff often would come to her office during this time with questions or would add a patient who walked in early to her schedule.

"When I made patients wait because I needed to take my pump break, the office manager got upset with me," Montgomery said, even though she usually greeted these patients, told them why she was late and found them to be generally understanding.

Medical students and residents on surgery rotations especially have challenges as they work to set up pumping times around operating room time, Montgomery said.

"And everyone doing patient care needs to make arrangements for time away and coverage," she said.

When the only lactation room in the hospital is near labor-and-delivery or the neonatal intensive care unit, working mothers also must factor in "commuting" time, Montgomery said.

"It works much better if medical students and doctors can have private spaces near their workspace to express milk," she added.

Irregular hours also can make breastfeeding challenging for physicians and medical students, Montgomery said, and being away from the baby for 24 hours is especially challenging.

"It helps if a caregiver can bring the baby for some feeds during that time, but many hospitals do not allow young children," she said. "It also helps if physician moms can at least have the baby in the call room or other non-patient care area. Many moms end up feeding or pumping in their cars, which is not optimal!"

The facility Montgomery works in doesn't have an official lactation room for employees.

"When we have had a breastfeeding resident, we have allowed her to use office space in the educational building or an exam room in the clinic to express milk," she said. "We allow babies to visit their mothers and allow babies to be present for non-patient care activities like didactics."

Additionally, Montgomery said the clinic purchased a hospital-grade breast pump for staff to use, which should shorten pumping time for residents and staff.

"Modeling good practices and making sure physicians have good experiences on which to base their support for patients will help us continue to move our breastfeeding rates higher," she said. "This webinar can help highlight best practices for breastfeeding support in health care facilities."