P2B057: Lactation Culture of Pediatric Emergency Medicine Fellows: A National Survey Study

Background: Breastmilk has been shown to decrease infant infection, childhood mortality rates, and improve maternal health outcomes. However, physicians, especially trainees who have children during residency or fellowship, may struggle to lactate (breastfeed or pump breastmilk) given structural and cultural barriers. Specifically, pediatric emergency medicine (PEM) fellows, who may benefit from the relatively more supportive culture of pediatrics, still encounter many challenges inherent in staffing a busy emergency department (ED). This is the first study that aims to assess the lactation culture and needs of PEM fellows, providing the homogeneity and increased sample size lacking in prior studies.

Methods: This is a cross-sectional national survey study distributed via the PEM-Program Director (PD) Survey Committee. Two surveys were developed using an iterative review process: one for program directors (10 questions) and one for PEM fellows (on average, 25 questions). Questions used branching logic and addressed demographics and lactation policy awareness. The fellow survey also included questions on departmental support, lactation devices and time spent lactating, and access to a designated lactation space. Surveys were distributed three times over a six-week period. The program PD was requested to complete the survey and to forward the fellow survey to all their trainees. Fellows with the current or potential ability to lactate were invited to participate in the survey. All responses were anonymous.

Results: 39% (35/90) of PDs, a majority of whom are at academic programs (91%, 32/35), responded to the survey one-week into the study. An estimated 67% (195/293) of their PEM fellows had the potential or current ability to lactate. 31% (60/195) of eligible fellows completed the fellow survey. 97% (58/60) completed General Pediatrics residency prior to starting fellowship. 40% (24/60), 37% (22/60) and 23% (14/60) of fellows were in their first, second and third years of fellowship, respectively.

38% (23/60) of fellows had some personal experience with lactation and another 23% (14/60) hoped to lactate during fellowship. With regards to departmental support, 57% (20/35) of PDs and 43% (26/60) of fellows knew of a lactation policy for PEM fellows. While most fellows did not base their decision to lactate based on knowledge of such a policy, some fellows felt confusion, difficulty, or unsupported. Nonetheless, 97% (36/37) of fellows somewhat or strongly agreed that their workplace was supportive of lactating fellows.

Conclusion: Our results show that lactation is desired and expected in a large proportion of PEM fellows. While the lactation culture of PEM appears to be overall supportive, continued establishment of formal policies and means to ensure awareness of these policies is imperative. These policies may include guidance on schedule accommodations and breaks for lactation, and access to lactation equipment and space.