647 - Don't Bite the Hand that Feeds You: Supporting Breastfeeding Parents in the Pediatric Emergency Department

Publication Number: 647.4613

Rachel Weigert, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, United States; Shea Lammers, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, United States; Amanda Nickel, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, United States; Katie DeWitt, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, United States

Background: Six months of exclusive breastfeeding is recommended, and legal breastfeeding protections have been in place since 2010. Physician mothers have a higher rate of breastfeeding initiation and early cessation than the general public. Of the approximately 3,500 practicing Pediatric Emergency Medicine (PEM) physicians in the United States, almost 70% are female. Pumping while working in the Pediatric Emergency Department (PED) remains challenging, and there is a gap in research regarding PEM physicians and their breastfeeding plans.

Objective: To determine factors that impact breastfeeding and pumping behaviors in PEM physicians including fellow or attending status.

Design/Methods: In this cross-sectional survey we asked about burnout, demographic factors, and breastfeeding/pumping behaviors. A subset who had pumped breastmilk were included for analysis. Data was collected from January 20 to April 1, 2024. Surveys were distributed through the Brown University PEM Listserv, and the PEM physician and Physician Mothers Groups on Facebook. Descriptive statistics were utilized to report primary outcomes, and Chi squares or Fisher’s Exact tests assessed differences among fellows and attendings.

Results: A total of 604 individuals began the survey for an estimated 17% participation rate, with 173 participants included in the breastfeeding analysis; 126 (73%) were attendings and 33 (19%) were fellows while pumping. Of all participants, 42% had a designated private pumping space in their PED, while 14% reported pumping in a bathroom or closet, and only 28% reported ideal space and resources to pump. Attendings pump less frequently and for less time than fellows (83% vs 56% report pumping less than 30 minutes per shift; p< 0.008), and 46% of all participants report being required to complete work tasks while pumping. Decreased milk supply was reported in 60% after returning to work, primarily attributed to decreased pumping frequency. Of PEM attendings, 98% report working single coverage, and 73% pump less often when they work these shifts; 19% of attendings vs 3% of fellows report that increased staffing would make it easier to pump on shift (p < 0.029). Regarding factors that make it harder to pump, attendings report increased impact compared to fellows by understaffing (25.4% vs 6.1%; p< 0.016), and business of the PED (35% vs 15%; p< 0.034), while more fellows report work culture as a factor that makes it harder to pump (21% vs 8%; p< 0.051).

Conclusion(s): Significant workplace and schedule improvements can be made to bolster physician satisfaction with the experience and longevity of pumping after returning to work.

Table 1: Participant Characteristics
Characteristics of participants included for analysis in the pumping portion of the study.

Table 2: Features of Workplace Pumping Spaces
Findings for both fellows and attendings regarding physical location and resources to pump while on shift.Table

Table 3: Workplace Culture, Leadership Supports, and Expectations While Pumping
Responses from attendings and fellows regarding both departmental and hospital leadership support, workplace culture, and on-shift expectations while pumping.

Table 1: Participant Characteristics
Characteristics of participants included for analysis in the pumping portion of the study.

Table 2: Features of Workplace Pumping Spaces
Findings for both fellows and attendings regarding physical location and resources to pump while on shift.Table

Table 3: Workplace Culture, Leadership Supports, and Expectations While Pumping
Responses from attendings and fellows regarding both departmental and hospital leadership support, workplace culture, and on-shift expectations while pumping.