Drs. Avika Dixit, MBBS, MPH and Lori Feldman-Winter, MD, MPH recently published an article (with co-author Dr. Kinga A. Szucs, MD, IBCLC) in the Journal of Human Lactation (JHL) titled, “Frustrated,” “Depressed,” and “Devastated” Pediatric Trainees: US Academic Medical Centers Fail to Provide Adequate Workplace Breastfeeding Support, a study of pediatricians who parent during their medical training and the substantial obstacles they face in achieving their own breastfeeding goals.
Drs. Dixit and Feldman-Winter were interviewed by Marie Hemming, IBCLC, a member of the International Lactation Consultant Association® (ILCA®) Medialert Team.
MH: What led you to investigate the issue of breastfeeding support at United States academic medical centers?
LFW & AD: There is an increased focus on improving work and life balance during medical training. We have seen that more pediatric residents are having children during residency and wondered what their breastfeeding experiences have been, given the rigors of residency, and the presumption that they may have difficulty.
We wondered how trainees balance the needs of their baby, specifically breastfeeding, with the demands of their profession and how this experience affects their practice. This led us to explore this issue more.
MH: What was the most surprising finding from the research?
LFW & AD: We were surprised to see just how strong the emotions related to barriers and challenges of breastfeeding [were]. It was really disheartening to see how passionate and negative these emotions were, upon not meeting their breastfeeding goals, as well as the finding that many agreed that this affected their interactions with their own patients.
AD: There is an obvious disconnect between what the profession preaches as an optimal health behavior, exclusive breastfeeding, and what the training institutions do in terms of supporting this choice. The word cloud here was striking; the bigger the word the more often it appeared in the responses. Words like disappointed, sad, guilty and frustrated [were] prominent.
MH: Pediatricians are at the forefront of supporting the mother-baby dyad during breastfeeding. What changes do you think can be made to improve the ability of pediatricians to provide effective support?
LFW: Graduate medical education (GME) programs, especially in pediatrics, need to be more proactive in making sure their trainees who have children during training are supported to meet their breastfeeding goals. This could mean longer leaves, more options for flexible schedules upon return, more apparent places and facilities to express milk, or onsite child care to facilitate breastfeeding during the workday. Successful trainees will be the best spokespersons for their colleagues seeking ways to support breastfeeding mothers.
AD: I agree with Dr. Winter. Pediatric training programs can lead the way for other GME programs in developing support for breastfeeding trainees with changes such as longer parental leaves, flexible schedules upon returning, easily accessible and good quality facilities for breastfeeding mothers at the workplace, etc.
MH: Were you able to look at the correlation between the breastfeeding support provided for pediatric trainees and the Baby-Friendly hospital designation of the facility where they were trained?
LFW & AD: We did not look at this, as we did not have these data, but, at the time of the study, there were very few academic medical centers designated [as Baby-Friendly hospitals]. Over the past few years, the number of Baby-Friendly hospitals that train pediatric residents has increased dramatically, with multiple national initiatives helping hospitals achieve designation, so a follow up study looking at this factor would be interesting.
MH: Working and breastfeeding is a well-documented challenge, and yet, economic pressures and inadequate leave policies leave many families with wage-earning breastfeeding parents. Pediatric training programs can lead the way in resolving this conundrum, beginning with their own family leave policies. What role can healthcare practitioners play in resolving this critical issue affecting the health of our society?
LFW: It is vital for health care organizations as well as private practices to model optimal leave policies, including paid leave and flexible options for return to work. There should be national policies that incentivize these accommodations.
AD: There is increasing impetus nationally to revise parental leave policies. Healthcare practitioners can be advocates both at their workplace and by supporting changes in national leave policies. At the workplace, not only can they support patients and co-workers, but [they] can advocate for leave policies and improvement of facilities; while, at the national level, healthcare practitioners can write to their representatives about changing leave policies.
Dr. Avika Dixit, MBBS, MPH, is a third year pediatric resident at Indiana University School of Medicine. She is the AAP Section on Medical Students, Residents, and Fellowship Trainees (SOMSRFT) liaison to the Section on Breastfeeding (SOBr).
Lori Feldman-Winter, MD, MPH, is Division Head of Adolescent Medicine at The Children’s Regional Hospital at Cooper and Professor of Pediatrics at Cooper Medical School of Rowan University in Camden, NJ. Dr. Feldman-Winter is recognized nationally and internationally for her work related to breastfeeding education programs and nutrition policy. She is the chair of the Policy Committee for the AAP Section on Breastfeeding, member of the AAP Task Force on SIDS, AAP representative to the United States Breastfeeding Committee (USBC), and National Faculty Chair for the National Initiatives for Children’s Healthcare Quality (NICHQ) Best Fed Beginnings Project. Most recently, she is consultant to the Kellogg funded CHAMPS Project Communities and Hospitals Advancing Maternity Practices, and the NJHA Mother-Baby Hospital Initiative.
Marie Hemming, IBCLC is the mom of three breastfed children (now 21, 17, and 16 years of age). She developed and taught a 20-hour breastfeeding class at the Florida School of Traditional Midwifery. She is currently volunteering as an IBCLC and lay community counselor at Birthline of San Diego, serving families living in poverty.