Despite research showing multiple benefits of breastfeeding and numerous physician associations publishing statements in support of lactation, including ASA, awareness and education on this topic are lacking, according to Adamina G. Podraza, MD, FAAP, FASA, President of the Illinois Society of Anesthesiologists and a member of its Committee on Women in Anesthesiology.

“Our colleagues know there are health benefits to breastfeeding and even legal requirements supporting lactating individuals, but they may not understand the many obstacles that lactating anesthesiologists face,” said Dr. Podraza.

“It’s always challenging to schedule time in the OR to breastfeed. I pumped for both my sons, aged 2 and 4. My colleagues covered for me, but I always pressured myself not to take too long. This can complicate a pump break because you have to relax so your milk lets down, which can be difficult because you’re still involved in patient care – doing patient notes and returning pages.”

Shreya Aggarwal, MD, an anesthesiologist with Mobile Anesthesiologists in Chicago, agreed. “It’s always challenging to schedule time in the OR to breastfeed. I pumped for both my sons, aged 2 and 4. My colleagues covered for me, but I always pressured myself not to take too long. This can complicate a pump break because you have to relax so your milk lets down, which can be difficult because you’re still involved in patient care – doing patient notes and returning pages.”

Problems also arise because of the unpredictability of an anesthesiologist’s schedule. “Breasts need to be emptied at regular intervals. However, that’s not always possible in the OR,” said Dr. Aggarwal. “This can lead to plugged ducts, mastitis, or decreased milk supply. It’s important to understand that a woman may have to pump by a certain time, or it could negatively affect her health, not just the baby’s nutrition.”

In addition, younger and early-career physicians and other clinicians may feel they don’t have the clout to ask for support from their colleagues or department leadership. They may also fear that prioritizing lactation may call into question their commitment to patient care or their career (Ann Emerg Med 2020;75:681-90).

To address these issues, ASA published the Statement on Lactation Among Anesthesia Clinicians (asamonitor.pub/3i8oqG3) in October 2021. However, since the statement came out during COVID, Dr. Podraza feels it may not have received the attention it deserved.

The five-point statement (asamonitor.pub/3i8oqG3) recognizes the needs of women physician anesthesiologists, residents and fellows, assistants, and nurse anesthetists who are breastfeeding. Recommendations cover allowing flexibility to pump and to be provided a location other than a bathroom with a sink and refrigerator; the need for coverage during pumping sessions; if choosing to use a wearable breast pump, the statement that breast milk is not an infectious agent according to the Centers for Disease Control and Prevention (CDC) and the Occupational Safety and Health Administration (OSHA); and encouragement to create a supportive culture by providing education about lactation and the needs of lactating clinicians.

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Wearable breast pumps (wireless devices worn under clothing and used to express milk without the restrictions of an external pump or motors) have been touted as an option for busy physicians, and for many, the devices work well (Breastfeed Med 2022;7:537-43). These pumps come with their own drawbacks, including not working for all women, costing upward of $500, requiring time to attach them and then to empty and store the contents, and being somewhat tricky to use in a clinical setting. “When they work, they provide you with some freedom. However, everyone I know who has used one has spilled the contents at least once, and breast milk is like gold,” said Dr. Aggarwal.

Support for lactating anesthesiologists must come from leadership and clinical colleagues. In addition to providing a clean, safe space to pump and store breast milk, organizations can establish a supportive culture by educating all medical personnel about breastfeeding and:

  • Making hospital-grade breast pumps available or subsidize the coast of wearable pumps
  • Allocating personnel and resources to provide coverage for lactation sessions
  • Developing policies that normalize lactation, solicit feedback, and remove barriers (Anesth Analg 2020;131:1304-7).

One of the best ways for clinician colleagues to improve the experiences of lactating individuals is through supportive communication.

“There are many female employees working in and around the OR, and it’s important to provide breast pumping resources and to establish a supportive culture,” stated Dr. Podraza. “Breastfeeding is a health issue, and we want people to know that we can do our jobs effectively and save people’s lives, even though we’re lactating.”