One mother’s common sense strategies for making breastfeeding a practical reality in the busy emergency department.

Before I had kids, the only people who truly needed me as a matter of life or death were my patients. Looking back, life was relatively easy. When I was working, all my energy was focused on the ED. When I was off work, I did whatever I wanted.

All that changed when we had kids. Our much anticipated twin babies came 2 months early and they were tiny, weighing 3 lbs 5 oz, and 3 lbs 8 oz. I could hold one in each hand. After 6 weeks in the NICU, they came home, instantly becoming my two little homecare patients. I attended to them with the same diligence and care I gave to my patients at work, but with the added knowledge that only I could do for them everything that they really needed to survive and thrive. Specifically, only I could breastfeed them, which, after learning about the health and psychological benefits of breastfeeding, I was committed to do.

Before I returned to work in the ER, I researched all the breast-pumps on the market and was shocked to find that the devices were from the middle ages. Modern medical technology couldn’t do better than these crazy devices that required me to stop everything and sit alone with my shirt off holding these bottles to my boobs for 20 minutes every 2-3 hours? How was I supposed to get anything done in the ER? How could I be an EP if I was sequestered with my shirt off when the next emergency was happening? I didn’t quite knokw how it was going to happen, but I knew I had to, “make it work.”

What transpired was eye opening. More often than not, I would delay pumping until all my patients were stabilized or their disposition determined. I would tell myself that I would pump as soon as I finished just one more task. Before I knew it, the shift was usually over. If I did manage to find time to pump, the session was not easy; I felt hurried, distracted and pre-occupied with the work at hand.

I sought the advice and experience of other mom/physicians. One colleague chose to work all night shifts. She found the shifts were slower and shorter which allowed her the time to pump. Another chose formula feeding.

At the end of the day, I worried about resentment among my colleagues, and I still returned home feeling like a failure to my babies who were missing my company and the benefits of my milk. Over time, my milk supply diminished and we supplemented the twins’ feedings with formula more and more until they were weaned.

Breastfeeding in the Department: Making it work

• Some EDs have established coverage patterns for formal break time. If not, consider discussing what it would take to put this into regular practice. Or at least consider talking to colleagues about coverage for pumping before returning to work.
• Look into whether your ED has administrative tasks or projects that can be taken over during a transition period before returning to your regular clinical schedule. This would allow for scheduled pumping time.
• Consider taking a longer maternity leave if it is financially feasible for you.
  
• Consider returning to work with a reduced work schedule, either by splitting shifts with other doctors or working fewer shifts than you normally work.
  
• Start pumping after each breastfeeding session while awake; put milk in storage as soon as you can for future use.
  
• Drink plenty of water during your shift. Dehydration makes it hard to produce milk.
  
• Consider taking shifts when the ED might be a little slower.
  
• Look at the physical layout of your ED. Will you be using a private office, communal staff break room, patient care room, privacy screens around your work station, or a bathroom to pump? Try to create a situation where you can complete charting, dictations or phone calls while you pump, so that you can be more efficient and relaxed.
  
• Review all the breast-pump and hands free or portable models available. We are all different with respect to what we might be comfortable with among our co-workers, consultants and ancillary staff. Personally, I eventually got to a point where I didn’t care what anyone thought. I would pump in a meeting if I had to. As long as I covered up, why should anyone complain?
  
• Get rid of the guilt in your personal life and professional life. Your patients will survive, and your children will too. It is not the end of the world if the baby gets some formula. However much of your breastmilk you can provide will have to do. Likewise, your co-workers will get used to the fact that you need to pump. And besides, it is only for a limited time. Everyone has periods in their careers when personal or family priorities compete with their professional lives.
  
• Get creative. For me, that meant actually making my own breastpump – the Freemie system – which is a hands-free and concealable breast milk collection device that fits under your scrubs and attaches to your breast pump. My hope is that future generations of emergency doctors and moms will take pumping out of broom closets everywhere with a tool that allows them to pump wherever and whenever they need to.

Returning to work after having a baby is hard, physically and emotionally. Parents everywhere know that life after children is an ongoing struggle to maintain the balance needed between work and family. The decision to continue breastfeeding for EPs returning from maternity leave is no different. Keep in mind that the challenges of parenthood will change as you move through the many stages of your life, sometimes requiring sacrifices from either side. Try to plan ahead as much as you can, and do your best. You’ll be just fine.