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Am Fam Physician. 2003;68(11):2129-2133

See article on page 2199.

A young family physician recently returned to practice after taking a two-month maternity leave. She was grateful to her two male senior partners for allowing her to be at home with her first child. Although being away from her infant was difficult, she was excited about seeing her patients again. Well aware of the many benefits of breastfeeding, she was prepared to express her milk while at work and to continue nursing at night. She knew that she was fortunate to have her own office where she could store her electric pump and close the door when she needed privacy.

Things did not go as smoothly as planned. It took a fair amount of negotiating to arrange morning and afternoon breaks in the physician's schedule. Neither of her partners had ever taken paternity leave, let alone required “pumping breaks.” She also felt pressured to maintain her productivity. At first, patients were often scheduled during the two 15-minute slots in her schedule that were intended for pumping. Even on good days, it was challenging to get her office door closed, assemble the pump, think about her baby, and relax enough to achieve a good milk “let-down” within 15 minutes.

After several weeks, however, the office settled into a rhythm. With some strategic scheduling, the physician was able to expand her breaks to 20 minutes. The jokes about mistaking her breast milk for coffee creamer ceased, and her partners began asking her for advice about breastfeeding management. This physician was able to keep breastfeeding for 13 months.

Breastfeeding after returning to work has significant health and emotional benefits for mothers and their infants. However, no matter what a woman's profession is, working outside the home poses significant challenges to breastfeeding. In this issue of American Family Physician, Biagioli1 provides a thorough overview of the issues surrounding a nursing mother's return to work and the ways in which her family physician can support her in this challenging transition.

Family physicians should consider how we can support our colleagues, as well as our patients, as they continue breastfeeding after a return to work. Extended maternity leave, part-time work, and on-site child care all contribute to the solution, but these options are unlikely to be available to, or appropriate for, all working women. Individualized local solutions, often involving flexible scheduling, are necessary. Most importantly, we need to show our colleagues that we embrace breastfeeding as being best for mothers and children, and that we are willing to make the changes necessary to ensure that it succeeds.

Family physicians' offices can set an example for the entire business community about how to make breastfeeding work. Nurses, phlebotomists, and clerical workers face many of the same challenges to breastfeeding as physicians, without having a private office space. Lactation rooms benefit office staff as well as patients. How much easier it will be to write a letter to our patient's employer when we ourselves have instituted the changes that we are advocating.

We also can become advocates for breastfeeding-friendly work policies in our hospitals. As large employers, hospitals quickly will reap the benefits of improved morale, increased employee retention, and decreased days missed from work to care for sick children. The Aetna insurance company reported that it saved more than $1,400 and three sick days per breastfeeding employee in the first year of its employee breastfeeding support program.2

And let us not forget residents. Family medicine residents report both high interest and strong commitment to breastfeeding, as well as high breastfeeding initiation rates in those who have given birth.3 However, these residents also have relatively high rates of weaning once they return to work.3 Even within an 80-hour work week, there can be time to express breast milk if residents have support.

While we are on the way to achieving our Healthy People 2010 goal of having 75 percent of American women choose to initiate breastfeeding in the immediate postpartum period, we are making less progress toward meeting our more limited goal of having 50 percent of mothers breastfeeding at six months.4 As a society, we must remove the barriers to breast-feeding after women return to work. As family physicians, we can remove these barriers in our offices to benefit our patients, our staffs, and ourselves.

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