Physician Mothers and Breastfeeding

Suggestions to Improve RatesMaryam Sattari, MD

Breastfeeding Recommendations

• Exclusive breastfeeding for first 6 months of life• Breastfeeding should then continue, with addition of

complementary foods, through age 12 months and beyond, if desired by mother and infant.

World Health Organization, United Nations Children’s Fund. Global strategy for infant and young child feeding. Geneva, Switz: World Health Organization; 2001.

Breastfeeding (BF): Cornerstone of Preventive Medicine

• Infant health– sudden infant death syndrome, otitis

media, respiratory tract infections, gastroenteritis, atopic dermatitis, diabetes, obesity

• Maternal health– breast cancer, ovarian cancer, and

type 2 diabetes • Economic• Environmental

Ip S et al. Evid Rep Technol Assess 2007;153:1-186.

Breastfeeding Rates of Physician Mothers

0102030405060708090100

Initiation 6 months 12 months

Miller 

Arthur

Kacmar

Arthur CR et al.. South Med J 2003;96(2):130-5.Miller N et al. Pediatrics 1996;98(3):434-7.Kacmar JE et al. Med Health R I. 2006 Jul;89(7):230-1.

Physician Mothers vs.

the General Population

Sattari M et al. Breastfeed Med. 2010 Feb; 5:35-9.

Background

• Maternal occupation as a physician seems to be a risk factor for premature breastfeeding cessation.

• Sattari M et al. Breastfeed Med. 2010 Feb; 5:35-9.

Reasons for Breastfeeding Cessation

-Return to work-Diminishing milk supply-Lack of time to express milkArthur CR et al.. South Med J 2003;96(2):130-5.Miller N et al. Pediatrics 1996;98(3):434-7.

7

BF continuation rates dropped by half as resident mothers returned to work.Miller N et al. Pediatrics 1996;98(3):434-7.

Obstacles to Breastfeeding after Return to Work

– Lack of space for milk expression– Lack of time for milk expression

Arthur CR et al.. South Med J 2003;96(2):130-5.

Enablers and Obstacles

9

Return to Work/ work 

schedule

BFMaintenance by 

Physicians

Diminishing Milk Supply

Lack of time to Express milk

Lack of place to pump milk

Length of Maternity Leave

Formal BF Education

Maternal Intentions

Purpose

• To explore the breastfeeding practices as well as intentions of physician mothers

• We also developed questions to explore study participant (physician mothers’) perception as far as changes and interventions to encourage breastfeeding after return to work.

Methods

• Criteria for participation:– Physician– Female – At least one biological child– Willingness to participate in the

study.

Methods

• Some multiple choice and mostly open-ended questions

Results

• 50 physicians included in the study had 86 children.

• Average age of participants was 36.8 years (range from 28-54).

Demographic Data for Physician Mothers in the Study (N=50)

N %

Age

28-30 5 10

31-34 13 26

35-39 20 40

40+ 12 24

Marital Status

Married 45 90

Not married 5 10

Training level

Post training 38 76

In training 12 24

Number of children

1 20 40

2 25 50

3 4 8

4 1 2

Specialty Distribution of Physician Mothers in the Study (N=50)

Specialty N %

Anesthesiology 3 6

General surgery 2 4

Internal Medicine (IM) or an IM subspecialties

34 78

IM/Pediatrics 1 2

Obstetrics/Gynecol ogy

2 4

Neurology 4 8

Pediatrics 1 2

Rehab 1 2

Ophthalmology 1 2

Urology 1 2

Breastfeeding Intentions versus Breastfeeding Behavior

Intent to breastfeed (%)

Actually breastfed (%)

Hospital discharge 100 97

12 months 64 42

01020

3040506070

8090100

Birth 12months

Intention

Actual

N= 86 12 months or longer(n=35)

6 months and longer up to 12 months

(n=27)

1 months and longer up to 6 months

(n=12)

Less than 1 month(n=2)

Other 40%

Infant Interest 34% 33%

Inadequate milk supply

17% 37% 83.3%

Inadequate time 8.6% 44.4% 25%

Too stressful 5.7% 7%

Maternal health 2.9% 100%

Maternal discomfort 2.9%

Maternal interest 2.9% 7%

Infant health 2.9% 8%

Reasons for Breastfeeding Cessation Based on Infant age at time of Cessation (mothers could provide multiple reasons)

N= 86 12 months or longer

6 - 11.9 months 1 – 5.9 months Less than 1 month

Other 40%

Infant Interest 34% 33%

Inadequate milk supply

17% 37% 83.3%

Inadequate time 8.6% 44.4% 25%

Too stressful 5.7% 7%

Maternal/Infant health

2.9% 100%

Maternal discomfort

2.9%

Maternal interest 2.9% 7%

Most Common Reasons for Breastfeeding Cessation

Maternal Intentions

• While 62% of mothers wanted to breastfeed for at least 12 months and while 97% initiated breastfeeding at birth, only 41% of infants were breastfed at 12 months.

• This discrepancy suggests that work-related factors not only influence physician mothers’ breastfeeding behavior, but might have a larger impact than these mothers’ education and intentions on breastfeeding duration.

• Sattari M et al. Breastfeeding Med, 2010 June, Epub.

Physician Mothers’ Suggestions to Encourage Breastfeeding Continuation after Maternity

Leave

Categories %

Dedicated space for milk expression 88

Adequate time for milk expression 56

Supportive Health Policy 44

Dedicated Space for Milk Expression

• Lactation rooms/more lactation rooms• Sanitary storage for breast milk• Sink inside/close to lactation rooms• Onsite daycare

Adequate Time for milk Expression

• Non-clinical rotations• Shared / part-time residency• Part-time employment opportunities• Protected time for milk expression

Supportive Health Policy

• Formal maternity leave policy• Increased paid leave• Educational campaigns to promote workplace

awareness that BF for the first 6 months is optimal

Conclusion

• Many of the suggested work-place changes analyzed in this study are simple and practical interventions that merit further considerations in residency programs and medical practices to enhance breastfeeding duration among physician mothers returning to work.