For the broader O&G Magazine readership, Q&A seeks balanced answers to those curly-yet-common questions in obstetrics and gynaecology.

How do I return to work and still provide breastmilk for my baby?

Dr Heather Waterfall returned to her private O&G practice when her twins were eight weeks old and Dr Candice Houda returned to work as an AGES Fellow when her daughter was six months old. Between them they have pumped or fed babies through theatre cases, telehealth appointments and hospital and RANZCOG Council meetings.

Many of us have combined becoming parents with return to work as an O&G; returning to work while breastfeeding (or the ‘food lady’ as Candice has been affectionately nicknamed in her house) adds another challenge. Performing well and contributing to the team are important, but so is providing breastmilk for our babies, and for most women this means pumping/expressing milk at work.

Why is pumping/expressing necessary for breastfeeding women when they return to work?

Breastmilk supply is reliant on frequent and effective breast emptying. Breastfeeding women need to express milk approximately every three hours for about 10–30min. Long gaps between pumping sessions and inadequate food and drink intake can lead to engorgement, discomfort, mastitis, a drop in milk supply and the risk of premature weaning.

Every three hours? How is that possible at work?

It is every employee’s legal right to have a break to express breastmilk, and it is important that women are supported to pump in a place of their choosing. Tell your team you need to stop and express, and have a plan in place to make pump breaks happen. Don’t be embarrassed to tell people you need to pump, most people will admire your determination. By expressing at work and talking about breastfeeding we are normalising it. By doing this we can make it easier for junior doctors and nurses who come after us, who may not feel as able to speak up and ask for pumping time.

Practical tips for pumping at work

Essential kit: a battery powered double pump (Heather uses a Spectra S1) with a pumping bra for handsfree pumping, or a wearable pump (though more expensive) can be a timesaver allowing multitasking, examples including Elvies, Willows, Spectra Wearable (Candice’s preference) and Freemies. If possible, have two complete sets of flanges/valves in case you get called in and need a clean set of kit. It is also important to replace pump parts regularly, in particular if you find pump volumes have dropped.

Buy a cooler bag with an ice-brick (if you don’t have access to a convenient fridge), store your pump parts in a Tupperwear container in the bag and they only need to be washed every 24 hours. After trying a few options, milk bags and hospital specimen pots make excellent storage if you forget bottles. A cloth is always handy in your pack, plus nipple cream, a water bottle and snacks to ensure you eat and drink with every pumping session.

Videos/photos of your baby can help with a let down. Don’t think about how much (or how little!) milk you are making, put a cover over the bottles so you can’t see how much milk is there and instead think about your baby, or alternatively multitask with letters/operation notes/email/social media. ‘Hands on’ pumping with breast compressions may help increase volumes whilst expressing.

Starting the day ‘empty’ helps build up supply, and pumping in the car on the way to work takes minimal effort. This requires a wearable pump or a large scarf over traditional flanges with a handsfree pumping bra.

In theatre: pump before every major, even if it’s a ‘short one’. A wise urologist suggests ‘if in doubt, pump.’ Whilst not for everyone, it is possible to scrub in for major cases with wearable pumps in (although you can resemble Dolly Parton). Let the team know discreetly when you turn them on, start pumping at skin closure or during the check cystoscopy to save time. If a wearable pump isn’t suitable then a private place to pump between cases is necessary – a private office with a lockable door ideally, but a shower cubicle in the change rooms might be the most practical option. It is not acceptable to be told to pump in a toilet, nor should you have to use a pumping room on the other side of the hospital.

In clinic: If you can, block out time in your clinic to pump – make an appointment with your baby. Or block out time for phone appointments and pump and talk at the same time.

Pumping on call: O&G can be unpredictable, if you get called in and will miss a feed, ideally you need to pump around the time of the missed feed. Pump in the car on the way in, or while waiting for theatre or writing the delivery note. Better to pump earlier than a usual feed time otherwise you risk missing the feed/pump entirely, with resultant engorgement and potential trigger for decreased supply.

All day training/meetings: almost all meetings now have the ability to join via Zoom/Teams. You can leave a face-to-face meeting and then join online while you are pumping, then return to the meeting face-to-face.

If you are caught out at work without pumping equipment, obstetric hospitals have hospital grade pumps available for patients to use, and often will let staff use them if needed in an emergency. It is even possible to use Uber parcel delivery to have your forgotten pump delivered to work.

When can you stop pumping at work?

After baby turns one and is reliably on solids, breastmilk intake will likely drop, and as supply = demand, breastmilk supply will likely drop as feeds become less frequent. The frequency of pumping can therefore be slowly decreased, though many women still choose to continue a lunchtime pump for comfort and to maintain supply if their baby would normally feed at this time. If you are away from baby for more than 12 hours, pumping remains necessary to maintain supply and not risk mastitis.

The WHO recommends breastfeeding until two years of age, though there can be societal pressure to stop feeding or pumping earlier than this. As doctors we can normalise breastfeeding by talking about it and continuing to pump at work as needed, and supporting others to do the same.

Further reading

• York N, Barnes T. Supporting Breastfeeding Surgeons. Surgical News. 2021;22(5):36-7.
• Dr Milk Facebook group
• MAMMTB Lactation Interest Facebook group for any doctor regardless of gender
• Work. Pump. Repeat. Jessica Shortal
• World Health Organization articles and guidelines www.who.int/health-topics/breastfeeding
• World Breastfeeding Week 2021 waba.org.my/wbw
• Women in Surgery www.surgeons.org/en/Resources/interest-groups-sections/women-in-surgery
• AAFP policy for medical trainees on lactation www.aafp.org/about/policies/all/breastfeeding-lactation-medical-trainees.html

Our feature articles represent the views of our authors and do not necessarily represent the views of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), who publish O&G Magazine. While we make every effort to ensure that the information we share is accurate, we welcome any comments, suggestions or correction of errors in our comments section below, or by emailing the editor at [email protected].