‘Do we have space to pump’: Another barrier for female physicians

More than half of Canada’s young doctors may be women, but our hospitals have not kept pace with this gender shift, forcing breastfeeding physicians into shower stalls, bathrooms, hallways and makeshift lactation spaces. Rarely is there a semi-private space for them to pump their breasts or a secure place to store the milk; and time to do both is a premium.

The result is Stone Age practices frequently criticized in cross-Canada online chatrooms, punctuated with comments like, “I hoped the culture had changed.” 

• Yellowknife’s ICU physician Meghan Leitch covertly found space at the back of the teaching room in her unit, back turned to a glass window, next to a door, to pump. She “didn’t think to advocate for (herself).” Leitch says. “I just felt lucky to have a job.”
• Brantford anesthesiologist Crystal Chettle often retired to the floor of an unused shower stall, “holding the pump in one hand and eating with the other.”
• Montreal’s Sara Ahronheim had no space or time in her emergency unit so she depended on “freemies” – hands-free concealable breast pump collection cups that fit inside a bra. When she had to run to a resuscitation in the ER she’d pull out the tubing, leave the freemies snugly in place in her bra, run to the patient, and finish the pumping session after.
• Some, fearing they’ll lose the precious milk they’d adroitly extracted – even a storage fridge is often not available – send home the milk via Uber or taxi.

And while these examples may seem preposterous, the consequences can be serious. Some female doctors have weaned their children off breast milk prior to returning to work, frustrated at the workplace deficiencies; others have seen their milk dry up and suffer complications like clogged ducts, mastitis and breast abscess.

This is “ridiculous – an example of something completely overlooked because it’s not an issue or need for the people at the top,” says family physician Michelle Cohen, of Brighton, Ont. Men don’t see the problem while women endure it as one of their barriers in medicine.

“It’s a glaring problem and a gap that needs to be addressed,” says the assistant professor of medicine at Queen’s University.

Cohen is one of many female physicians on the Canada Women In Medicine (CWIM) Facebook group, where more than 100 women have shared their experiences of pumping at work. Some because they “wouldn’t want anyone else to feel the way (they) did at that time” and others because they “hoped the culture had changed.”

Kirstin Pirot, an anesthesiologist in Lethbridge, Alta., who had four children spread across residency and staff appointments, recalls having mastitis while on an emergency medicine rotation because she had no time to get away and express her milk. As a “learner (you) are so concerned about the impression you’re making,” she says. She eventually gave up breastfeeding her first child at five months.

“The frustrating thing is that as physicians, we know about the benefits of breastfeeding, so why don’t we have enough supports to help our colleagues?” Pirot asks. “That’s the disappointing part.”

The Public Health Agency of Canada, Health Canada and the World Health Organization recommend breastfeeding until six months and continuing to breastfeed up to two years or more after introducing solid foods.

Canadian physicians do not qualify for paid maternity leave programs. Instead, they can apply for a benefit program that is capped at a maximum of $1,000 a week for nine weeks. Many physicians must return to work weeks after child birth to meet clinical demands and commitments or keep up their surgical skills. Medical residents need to ensure they meet requirements in order to write their licensing exams with their peers.

Previous studies and many women in the CWIM group reported that even if you can find the time and space to pump, there is no adequate place to store your milk. Some even stored their milk in fridges where drugs and vaccines are kept. Milk was also stored in shared fridges where others kept their lunches. Some women reported collegial jokes about this, while others experienced verbal abuse.

Medicine, previously a male-dominated profession, has not responded as it should to a gender shift. As of 2018, women accounted for 41 per cent of licensed physicians in Canada. And the wave of women is reflected in this statistic: 54 per cent of physicians under age 45 are women.

Women in medicine start their careers during their peak reproductive years. Despite legal protection in some workplaces around the world, female physicians are less likely to meet their breastfeeding duration goals compared to women in other professions. For one, hospitals are busy places with little down time, and male hospital directors didn’t think to make space for their mom colleagues.

Sara Ahronheim, an attending emergency physician at the Jewish General Hospital in Montreal, went back to work four months postpartum. There was no designated place for her to pump, but if there was, she “would not have felt comfortable leaving (her) unit for that long.” And so she would regularly pump while doing rounds and reviewing cases with residents.

Erica Dance, an emergency physician in Edmonton, recalls that back in the day they would just make do, find a bathroom, call room or a sympathetic staff’s office to pump. There was a low expectation of someone setting up a lactation room. When Dance took over the resident wellness committee, she began noticing that female physicians returning to work were calling her asking “do we have a space to pump?”

In 2017, the realization that it was no longer appropriate “to just make do” set in and was replaced with “why aren’t we doing something about this?”

It took two years, many emails, committee meetings and working with a space planner to overcome barriers of space, ownership of space, safety and money, but there are now lactation rooms in all four hospitals in Edmonton. Many people at the table were “surprised it was still an issue and had not been sorted out before,” says Dance. There was “universal acceptance that this was an important issue.” 

Dance adds that “there is no question this should be a part of future hospital planning” and that “creative minds could plant these rooms in the right spots.”