Breastfeeding Surgeons

A tutorial series for breastfeeding surgeons: tips and pearls for success.

Mission Statement

Pre-Survey

Meet Our Team

Program Leader Testamonials

TABLE OF CONTENTS

Work Smarter not Harder

Setting up for Success

Accommodating Your Schedule

Different Pumps for Different Needs

Potential Obstacles

Be an Advocate

Peer Testamonials

Troubleshooting

TABLE OF CONTENTS

Final Thoughts and Advice

Resources

Post-Survey

Thank you to AAO-HNS WIO Endowment Grant and UK Healthcare for supporting this project

This is not an exhaustive review. We have no preference for specific products or brands

mission statement

before continuing

Please complete our pre-survey prior to utilization of this research.

TAKE SURVEY

The survey is anonymous and will be used to understand current attitudes and obstacles facing breastfeeding surgeons. A cover letter detailing this is provided at the link above. Don't forget there will be a post-survey too!

Meet Our Team

Dr. Tessa E. London-Bounds, MD

Dr. Nikita Gupta, MD

Dr. Brittany Levy, MD

Assistant Professor Cardiovascular and Thoracic Surgery

Assistant Professor Otolaryngology Head and Neck Surgery

General Surgery Resident

Be flexible with your goals, it is okay if they change. Each child, each parent, each circumstance is different.

The reason we are here

"As long as your child is fed, you have done your job... It doesn't matter if the milk came from you, from a donor, or from formula"

LEADERSHIP TESTAMONIALS

Everyone navigates the journey at their own pace.

LEADERSHIP TESTAMONIAL

Everyone navigates the journey at their own pace.

• Have extra supplies/pumps in different locations to reduce your mental load
• Be open to trying different types of pumps
• Consider borrowing, renting or buying used parts to save money

product

Showing enthusiasm, smiling, and maintaining eye contact with your audience can be your best allies when it comes to telling stories that excite and capture the audience's interest: 'The eyes, chico. They never lie'. This will help you connect with your audience. Knock their socks off!

Work Set Up

• Consider having multiple sets of materials so you don't have to transport everything back and forth

• You can store milk in bottles that you feed with or store in bags to save space

• Use a fridge, cooler, or insulated bottle to store milk

Home Set Up

• You can use a plug-in model at home and keep your portable or wearable devices at work

LEADERSHIP TESTAMONIALS

Set Expectations

• Think about your pumping plan, but know that you can change things as you go

• Don't be afraid to ask for help and support from peers and co-workers to maintain structure in your schedule

Accommodating your Pumping Schedule

• Talk to your team, people are generally understanding

• Consider wearable pumps to maintain productivity

Attending Schedule Example 1

Attending Schedule Example 2

Attending Schedule Example 3

Timing is Key

• Pumping needs are different

• Talk with your supervisor and/or clinic manager about times that work for you

• The schedule below is an example of utilizing a lunch break for pumping

Different Pumps for Different Needs

General Tips

• Practice assembling the pump before you go back to work to maximize efficiency

• Do fewer dishes! There are ways to directly pump into a bottle/bag, such as using a Kiinde twist bag, or using an adapter to directly attach a bottle
• Bags are helpful for freezing extra milk

• Lactation rooms may not always be accessible, so you can use an office or other private area (legally there is supposed to be a space that is not a bathroom)

Practice Makes Perfect

Traditional Pumps

Spectra Pumps

product

Showing enthusiasm, smiling, and maintaining eye contact with your audience can be your best allies when it comes to telling stories that excite and capture the audience's interest: 'The eyes, chico. They never lie'. This will help you connect with your audience. Knock their socks off!

Medela Pumps

Wearable Pumps

• Both options are cordless, can wear under a nursing bra
• Make sure all the pieces are in place to provide adequate suction

• Come in multiple sizes
• May be eligible to use FSA/HSA funds to purchase

Willow

Can pump directly into milk bag or pour out of canister into another vessel

Elvie

Similar set up, but there is no storage bag option

Haakaa Pump

• Simple silicone piece that uses natural seal to create suction

• Can utilize after direct feed or for full pumping session

• Does not require battery

• Gentle suction compared to wearable pumps

product

Kiinde Twist

Showing enthusiasm, smiling, and maintaining eye contact with your audience can be your best allies when it comes to telling stories that excite and capture the audience's interest: 'The eyes, chico. They never lie'. This will help you connect with your audience. Knock their socks off!

• Attaches directly to most breast pumps to pump directly into a pouch
• Pouch can be used to store milk or feed with an adaptor nipple

More Product Information

*This list is not exhaustive, there are multiple types within each brand, and there are updates to come.

Medela Symphony Breast Pump

Spectra S1 and S2 Breast Pump

Willow 3.0 Breast Pump

Elvie Breast Pump

A Portable Storage Option

Ceres Chill

• Can connect most breast pumps directly to the container
• Store breast milk for up to 20 hours
• Holds up 34 oz of milk

Other Gadgets to Consider

Haakaa Breast Pump

Kiinde Twist Bags

"I felt that people almost looked down upon me like I was taking my own time to do this as opposed to feeding my child."

Obstacles You May Face

"It adds an extra layer of difficulty if you are protecting people from pumping."

We can Normalize Breastfeeding

Be an Advocate

Check your institution, as many GME offices have implemented wearable breast pump programs.

Per ACGME requirements, "The program, in partnership with its Sponsoring Institution, must ensure healthy and safe learning and working environments that promote resident well-being and provide for...clean and private facilities for lactation that have refrigeration capabilities, with proximity appropriate for safe patient care"

• 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, as outlined in VI.C.1.d).(1).

program requirements

A GME Wearable Breast Pump Program: An Innovative Method to Meet ACGME Requirements and Federal Law

Addressing the Barriers to Pumping

Expansion of the Program

Initial Intervention

Breast pumps are not currently covered by health insurance. (Approx. $500 per unit)

KUGME initially purchased 3 Elvie wearable pumps and five mini-fridges to loan to residents for up to 1 year.

After a successful initial response, they expanded this to 9 wearable pumps, and 7 mini-fridges.

Kansas University Graduate Medical Education (ACGME) interviewed residents and attendings who were actively or previously breastfed It was suggested that a wearable pump program could eliminate barriers to breastfeeding including time, physical space, clinical work productivity, and milk production

Read Full Article

Got Milk? Design and Implementation of a Lactation Support Program for Surgeons

• Residents at the University of Michigan prepared the "University of Michigan Department of Surgery Guidelines for Lactating Surgical Residents" after exploring specific challenges that prior trainees faced
• Recommendations included
• Converting underutilized call rooms and offices to priority lactation spaces
• Emphasizing the wellness of postpartum residents

• The department of surgery at University of Wisconsin furthered this effort by adopting a 'cross-coverage model' to help cover lactating residents in the operating room during non-critical portions of the case to provide time for pumping

Read Full Article

Download guide

"The other obstacle I really encountered was really trying to straddle the line of when I wanted to be treated differently because I was a mom and what I felt like was having this new superpower...but in other ways, I didn't want anyone to treat me differently, so I didn't want to be a mom surgeon or a female surgeon. I just wanted to be a surgeon"

product

Showing enthusiasm, smiling, and maintaining eye contact with your audience can be your best allies when it comes to telling stories that excite and capture the audience's interest: 'The eyes, chico. They never lie'. This will help you connect with your audience. Knock their socks off!

Give Yourself Grace

"At the end of the day, [pumping, breastfeeding or bottle feeding] doesn't matter. You're going to have a bond with your child because you love them."

Know Your Rights as a Trainee

ACGME requirements

AAFP recommendations

"I am now a mom first and a trainee second"

product

Showing enthusiasm, smiling, and maintaining eye contact with your audience can be your best allies when it comes to telling stories that excite and capture the audience's interest: 'The eyes, chico. They never lie'. This will help you connect with your audience. Knock their socks off!

Based on survey responses, faculty did not feel knowledgeable enough to provide support to residents who are pumping

"Respondents expressed the need for policies that clearly establish support for breast pumping. These responses reflect recent efforts across specialties to increase inclusivity by providing private and accessible lactation facilities and cultivating cultural change"

Read Full Article

The following content provides more information to troubleshoot common problems.

*This includes some external resources.*

Mastitis

• Look out for engorgement, fevers, may have a rash or erythema
• Ok to continue pumping and feeding with mastitis
• Try warm compresses, pump/feed in 'all fours' position
• If symptoms persist or pain worsens may require antibiotic treatment

Cracked Nipples

• Cracked Nipples
• Consider nipple cream
• Non-toxic to infants, safe to use prior to feeding
• Avoid wearable pumps or high suction devices to allow things to heal

There are some bumps along the road

Low Supply

A fed baby = happy, healthy baby

• It is OK to supplement with formula!

• Ways to increase supply:

• Increase breast stimulation
• Pump more frequently
• Pump for a longer period of time
• Nourish yourself
• Increase daily caloric intake by around 500 calories
• Consider two extra snacks or one extra small meal
• Hydrate hydrate hydrate

Low Supply

Check out the resources bellow for more common problems and solutions, or click here to see the full site.

*All recommendations are evidence based*

Feeding Concerns

Trash the Pump and Dump

Mythbusters

Infant Concerns

Feeding by Age and Stage

Mom Concerns

Surgery and Breastfeeding

Breast Cancer and Breastfeeding

Pregnancy and Lactation

About the Author of "Physician Guide to Breastfeeding"

The Physician Guide to Breastfeeding, created by Dr. Katrina Mitchell, provides scientific lactation information for healthcare providers, breastfeeding moms, and communities.

Read MORE

Final Thoughts...

...and advice

Suggested Institutional Breastfeeding Resouces for Medical Trainees

The ACGME sets standards for effective training programs, and monitors compliance with those standards (the Institutional and Program Requirements).

Discover how the AAFP and its members promote, support, and advance this vital role in patient and community health.

Article Links

• GME Wearable Breast Pump Program

• Lactation Support Program for Surgeons

• Surgery faculty knowledge and perceptions of breast pumping

Previously Mentioned External Resources

• Physician Guide to Breastfeeding

• Dr. Milk Facebook Group

Products Mentioned

• Haakaa Breast Pump

• Kiinde Twist Bags

• Ceres Chill

• Medela Symphony Breast Pump

• Spectra S1 and S2 Breast Pump

• Willow 3.0 Breast Pump

• Elvie Breast Pump

This project is brought to you by a generous grant funded by the American Academy of Otolaryngology - Head and Neck Society

TEAM

Thanks to our speakers and contributors for sharing their experiences!

Dr. Tessa E. London-Bounds, MD

Dr. Brittany Levy, MD

Dr. Nikita Gupta, MD

Video Contributor

Video Contributor

Video Contributor

University of Kentucky Assistant Professor Otolaryngology Head and Neck Surgery

University of Kentucky Assistant Professor Cardiovascular and Thoracic Surgery

University of Kentucky Resident General Surgery

Dr. Carly Clark, MD

Dr. Alexandra Kejner, MD

Dr. Amanda Saltzman, MD

Seth Applegate

Contributor

Editor

Contributor

Audio Visual Engineer

University of Kentucky Associate Professor of Urology General Surgery

University of Kentucky Healthcare

Medical University of South Carolina Associate Professor Otolaryngology Head and Neck Surgery

University of Kentucky Resident Otolaryngology Head and Neck Surgery

Thank you!

Check your inbox for a post-survey link

As long as you took the pre-survey, there will be a reminder email sent with a link for the post-survey.