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Faculty Development On-Shift Breast Pumping: 10 Tips for the Busy EM Resident
On-Shift Breast Pumping: 10 Tips for the Busy EM Resident
By Ashley Voroba, MD, on behalf of the SAEM Faculty Development Committee
I gave birth to my daughter at the end of my second year of residency. For the first 13 months of her life, I pumped breastmilk. It was the hardest thing I have ever had to do. I had no clue about breastfeeding or pumping before I did it. The extent of my training was less than one hour of didactic teaching in medical school and about the same amount throughout all of residency, mostly focused on medications and procedures that are contraindicated in breastfeeding. I received no guidance from my obstetrician about breastfeeding, other than that I should do it. In those 13 months, I learned more about breastfeeding, breast pumps, breastmilk storage, milk supply, and medications safety than I ever knew existed. For most of my information I relied heavily on forums and fellow emergency medicine residents and attendings who had experience with breastfeeding. There was a lot of trial and error. Now I find myself an unexpected breastfeeding and pumping
“Pump breaks are medically necessary to prevent mastitis and decrease in supply. You are providing food for your child. Pump breaks are not optional.” expert and advocate, especially as it relates to residents. In June 2022, the American Academy of Pediatrics (AAP) updated their recommendations on breastfeeding to align with the World Health Organization (WHO) recommendations which suggest
breastfeeding exclusively from birth to six months, and continued breastfeeding from two years and beyond. In honor of these changes, I’d like to share my top 10 tips for on-shift breast pumping for the busy emergency medicine residents.
1. Don’t let residency dictate your breastfeeding goals
The decision to breastfeed or not, and for how long, is completely up to the person making the milk. There will be challenges. There will be barriers to overcome. There will be bad days. There will be uncomfortable conversations. Don’t let someone else make the decision for your family.
2. Strategize with your team at the beginning of the shift how and when you will take your pump breaks
It’s always a good policy to have a brief chat with your attending and your onshift coresidents about the breaks you will take during the shift. Over time, as your colleagues get used to your pump schedule, this discussion will be less necessary. A good time to pump is during a lull, after seeing a few patients in a row, or after discharging a few patients. At my current shop, we take critical patients in a round-robin fashion, and I typically urge residents to take their breaks after our “hit,” when we are not “up” for another critical patient.
3. Don’t ask, tell
While we are on the topic of discussing your break schedule with the team, remember that this is not an ask. Pump breaks are medically necessary to prevent mastitis and decrease in supply. You are providing food for your child. Pump breaks are not optional.
4. When you can, take pump breaks early
This will give you “money in the bank” for later in the shift when things get hectic and you have to delay a pump break.
5. Multitask if you can
The space where you pump on shift should have a computer and a phone. One way to not feel like you are falling behind on shift is to chart, place orders, review results, call consults, write discharge papers and other EMR-related tasks while pumping. If you need to add extra pumps to your day, try pumping while driving to and from shift. If you find that you can’t multitask during your pump breaks, that’s okay too. Relax and pump.
6. Consider a portable pump
There are so many pumps on the market that allow you to pump on the go, without being attached to the wall. This could be an option that allows you more time on the floor and less time in the pump room. Remember that not everyone responds well to these pumps, so the default assumption should always be that you will need to take breaks to pump.
7. Eat and hydrate
It sounds basic, but how many times have you gone the whole shift without drinking water or eating a real meal? It’s essential while breastfeeding to keep up your water and calorie intake. Breastfeeding expends a lot of energy and you need to replenish.
8. Find your tribe and enlist help
You are not alone in this task. Join Dr. Milk on Facebook. Seek out attendings and fellow residents who have walked this road. They can be a wealth of information, support, and can help you advocate for yourself when needed. Have your partner wash pump parts and prepare them for the next shift.
9. Don’t quit on your worst day
This is a marathon, not a sprint. And there will be bad days. Give yourself grace. Reassess your goals. Press on.
10. Know your rights
The Accreditation Council for Graduate Medical Education (ACGME) Common Program Requirements states that “Sites must provide private and clean locations where residents may lactate and store the milk within a refrigerator. These locations should be in close proximity to clinical responsibilities. It would be helpful to have additional support within these locations that may assist the resident with the continued care of patients, such as a computer and a phone. While space is important, the time required for lactation is also critical for the well-being of the resident and the resident's family.”
While breastfeeding on shift while a resident has been one of the hardest challenges of my life, it is something I wanted to do and am grateful I was able to do. If on-shift breastfeeding is something you’d like to do as well, know that it is possible, even in residency, and that your EM colleagues will advocate for you, cheer you up, and cheer you on.
ABOUT THE AUTHOR
Dr. Ashley Voroba is an emergency medicine physician and the ultrasound director at St. Barnabas Hospital in Bronx, NY
