Abstract
This survey study evaluates the barriers to breastfeeding among a large representative nationwide cohort of physicians who are mothers.
The benefits of breastfeeding for both women and infants are well established.1 Despite recommendations from the American Academy of Pediatrics and the World Health Organization, initiating and sustaining lactation remains a challenge for many women.2 Although 79% of mothers in the United States initiate breastfeeding, only 27% are still breastfeeding at 12 months postpartum.3
Physicians who are mothers face substantial challenges that may undermine efforts to sustain lactation after they return to work. Elsewhere, we demonstrated that the career satisfaction of physicians who are mothers was negatively affected by the short duration of maternity leave, associated financial losses, and inflexible work schedules.4,5,6 Given the paucity of data on lactation practices among physicians who are mothers, the aim of this study was to use a large representative nationwide cohort to evaluate the barriers to breastfeeding for physicians who are mothers.
Methods
Data from physicians who are mothers were gathered via an anonymous online survey on the impact of pregnancy and maternity leave that used social media recruitment (Physician Moms Group), as reported elsewhere.4 Of the 14 518 members of the Physician Moms Group at the time of the study, 2363 mothers (16.3%) completed the survey. Women who were currently breastfeeding were excluded. Univariate analysis was performed using χ2 and Fisher exact tests. A multivariable model was also created to determine predictors of sustained lactation to at least 12 months postpartum and to personal goal. A 2-sided P < .05 was used to determine statistical significance. The survey was approved and the need for patient informed consent was waived by the institutional review board of Brigham and Women’s Hospital.
Results
The survey was completed by 2363 US physicians who were mothers, of whom 2224 (94.1%) initiated breastfeeding and 1606 (68.0%) met inclusion criteria. A complete case analysis was used for missing data. Overall, 670 of the 1606 respondents (41.7%) reported continued lactation to at least 12 months postpartum, and 450 (28.0%) reported that reaching their goal was the primary reason for cessation of breastfeeding (Table). Nearly half (788 [49.1%]) reported that they would have breastfed for longer if their job had been more accommodating. Characteristics associated with breastfeeding to at least 12 months postpartum were older maternal age, non-Hispanic race, nonprocedural specialty, longer time in practice, and having additional children. Having additional children and being a trainee were also associated with breastfeeding to personal goal. Respondents reported using a breast pump in their office (1045 respondents [99.2%]), in lactation rooms (207 [19.7%]), in call rooms (146 [12.8%]), and in their car (143 [13.9%]); 331 respondents (20.6%) used empty patient rooms, bathrooms, locker rooms, or closets.
Table. Demographic Characteristics of 1606 US Physicians Who Are Mothers Who Initiated Breastfeeding.
| Demographic Category | Breastfed to ≥12 mo Postpartum, No. (%) (n = 670 [41.7%]) | P Value | Breastfed to Personal Goal, No. (%) (n = 450 [28.0%]) | P Value |
|---|---|---|---|---|
| Age, y | ||||
| 25-30 (n = 76) | 25 (32.9) | .03 | 18 (23.7) | .07 |
| 31-35 (n = 806) | 318 (39.5) | 209 (25.9) | ||
| 36-40 (n = 593) | 274 (46.2) | 189 (31.9) | ||
| >40 (n = 131) | 53 (40.5) | 34 (26.0) | ||
| Race | ||||
| White (n = 1102) | 492 (44.7) | .003 | 326 (29.6) | .20 |
| Black (n = 65) | 26 (40.0) | 18 (27.7) | ||
| Hispanic (n = 42) | 10 (23.8) | 7 (16.7) | ||
| Asian (n = 293) | 101 (34.5) | 72 (24.6) | ||
| Other (n = 104) | 41 (39.4) | 27 (26.0) | ||
| Specialty type | ||||
| Procedural (n = 446) | 166 (37.2) | .02 | 111 (24.9) | .08 |
| Nonprocedural (n = 1160) | 504 (43.5) | 339 (29.2) | ||
| Trainee during last pregnancy | ||||
| Yes (n = 549) | 225 (41.0) | .67 | 136 (24.8) | .04 |
| No (n = 1057) | 445 (42.1) | 314 (29.7) | ||
| Current practice type | ||||
| Academic (n = 665) | 274 (41.2) | .36 | 176 (26.5) | .18 |
| Community (n = 351) | 160 (45.6) | 111 (31.6) | ||
| Private (n = 513) | 203 (39.6) | 145 (28.3) | ||
| Other (n = 72) | 30 (41.7) | 15 (20.8) | ||
| Duration of time in practice, y | ||||
| <4 (n = 983) | 435 (44.3) | .01 | 155 (24.8) | .03 |
| ≥4 (n = 623) | 235 (37.7) | 295 (30.0) | ||
| Spouse/partner occupation | ||||
| Full-time professional (n = 796) | 333 (41.8) | .30 | 22.4 (28.6) | .38 |
| Physician (n = 442) | 183 (41.4) | 123 (27.8) | ||
| Surgeon (n = 125) | 42 (33.6) | 28 (22.4) | ||
| Full-time parent (n = 150) | 69 (46.0) | 49 (32.7) | ||
| Other (n = 74) | 28 (37.8) | 18 (24.3) | ||
| No. of children | ||||
| 1 (n = 636) | 233 (38.1) | .02 | 136 (22.3) | <.001 |
| 2 (n = 771) | 315 (42.3) | 222 (29.8) | ||
| ≥3 (n = 270) | 122 (48.6) | 92 (36.7) |
The most frequently cited challenges to establishing a pumping routine in the workplace included inadequate time (1219 respondents [85.4%]), schedule inflexibility (529 [37.0%]), and insufficient space (332 [23.3%]; Figure, A). Respondents who reported longer maternity leave, dedicated space to pump, and accommodating schedules were more likely to report lactation to at least 12 months postpartum and to personal goal (Figure, B). In adjusted analysis, having a schedule that accommodated pumping was associated with increased odds of breastfeeding to at least 12 months postpartum (odds ratio [OR], 1.58; 95% CI, 1.26-1.98) and for breastfeeding to goal (OR, 1.60; 95% CI, 1.24-2.00). Having a longer maternity leave was associated with breastfeeding to at least 12 months postpartum (OR, 1.26; 95% CI, 1.02-1.56), and having a dedicated private space was associated with pumping to personal goal (OR, 1.44; 95% CI, 1.14-1.81; Figure, C).
Figure. Workplace Challenges, Accommodations, and Factors Associated With Breastfeeding.
A, Reported challenges to establishing a breast pumping routine while at work. B, Workplace accommodations and rates of breastfeeding to at least 12 months postpartum and to personal goal. C, Adjusted odds ratios (ORs) for factors associated with breastfeeding to at least 12 months postpartum and to personal goal. Models included those variables with statistical significance on bivariate analysis. Personal goal model was adjusted for number of children, trainee status, and time in practice. At least 12 months model was adjusted for age, race, procedural field, time in practice, and number of children. Error bars indicate 95% CI. RVU indicates relative value unit.
Discussion
Our findings suggest that 41.7% of physicians who are mothers who initiate breastfeeding sustain breastfeeding for at least 1 year. Although this finding exceeds the national rate of 27%,3 fewer than one-third of the respondents reported being able to sustain breastfeeding to their personal goal, and nearly half reported that they would have breastfed longer if their job had been more accommodating. Our findings suggest that modifiable, work-related factors—in particular, accommodating schedules to allow for pumping, providing longer maternity leave, and establishing a dedicated private space—may improve the ability of physicians who are mothers to continue lactation after they return to work. These factors should be taken into consideration when designing a workplace that is conducive to breastfeeding.
References
- 1.Victora CG, Bahl R, Barros AJD, et al. ; Lancet Breastfeeding Series Group . Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016;387(10017):475-490. doi: 10.1016/S0140-6736(15)01024-7 [DOI] [PubMed] [Google Scholar]
- 2.Section on Breastfeeding Breastfeeding and the use of human milk. Pediatrics. 2012;129(3):e827-e841. doi: 10.1542/peds.2011-3552 [DOI] [PubMed] [Google Scholar]
- 3.Centers for Disease Control and Prevention Breastfeeding report card: United States, 2014. https://www.cdc.gov/breastfeeding/pdf/2014breastfeedingreportcard.pdf. Accessed November 14, 2017.
- 4.Scully RE, Davids JS, Melnitchouk N. Impact of procedural specialty on maternity leave and career satisfaction among female physicians. Ann Surg. 2017;266(2):210-217. doi: 10.1097/SLA.0000000000002196 [DOI] [PubMed] [Google Scholar]
- 5.Davids JS, Scully RE, Melnitchouk N. Impact of procedural training on pregnancy outcomes and career satisfaction in female postgraduate medical trainees in the United States. J Am Coll Surg. 2017;225(3):411-418.e2. doi: 10.1016/j.jamcollsurg.2017.05.018 [DOI] [PubMed] [Google Scholar]
- 6.Scully RE, Stagg AR, Melnitchouk N, Davids JS. Pregnancy outcomes in female physicians in procedural versus non-procedural specialties. Am J Surg. 2017;214(4):599-603. doi: 10.1016/j.amjsurg.2017.06.016 [DOI] [PubMed] [Google Scholar]
