Breastfeeding in Medical School

My daughter was born during my second year of medical school, and I am happy to say that we exceeded our breastfeeding goal (exclusive breastfeeding for 6 months and some breastfeeding for one year). Negotiating third year with a breast pump in tow was definitely a challenge, though! If you are expecting to be toting your new friend Medela to your classes or rotations, there are a few important things to think about. So get comfortable, check all of your pump parts, lean forward just a bit, and let’s talk.

How often do you need to pump? 

This is a very personal question, and it’s going to vary depending on where you are in your “breastfeeding journey.” When my daughter was a newborn, I was guaranteed to have severe engorgement and plugged ducts if I didn’t pump or breastfeed every 2 hours. Yikes! That got better over the  next several weeks, but when I had to stop by school during my maternity leave, I had to plan things pretty carefully. By the time Indy 2.0 was three months old, I could space that out to every 4 hours, which made a big difference. What’s important is knowing your own body and how often you need to pump, not how often someone else says they have to.

Where can you pump?

The hospital where I did most of my rotations was pretty supportive of breastfeeding – they even had a breastfeeding room for employees! Unfortunately, there were a lot of other folks who were breastfeeding at the same time as I was. The room had an unofficial sign-up sheet where employees had signed up for 30-minute time blocks, and every minute was accounted for from 9am to 3pm. Um… what now? Some days I snuck in between other people and just tried to get in and out quickly. One day I waited 15 minutes out of my 30 minute lunch break only to have someone try to tell me that it was her turn next and  I had to go somewhere else. What??

Legal requirements for accommodating breastfeeding employees vary from state to state, but in my area at least, there are no laws protecting the rights of breastfeeding students. There are rules in some areas that require, for example, access to a private space in reasonable proximity to a sink and a fridge. As a student, this doesn’t apply to you. Sorry.

That being said, most places will provide you a reasonable space to pump if you just ask for it. This is especially important if you find yourself in a different location or with different staff every day. So how do you find a place to pump?

  • Bring it up early in the shift. Mention early on that you have an infant at home and you will need a place to pump during your breaks.
  • Be specific about what you need. Female attendings and nurses may have some experience with pumping, but odds are good that your residents will have no idea what makes a place appropriate for pumping. Make sure you ask specifically for what you need (more on this later).
  • Be flexible. Some places where I rotated had a lovely pumping room with a sink, a fridge, and a comfy chair. Other places offered me someone’s office while they were eating their lunch. Try not to be picky, within reason.

What makes an appropriate pumping space?

All you really need is a room with a door and a place to sit (chair, bed, couch, etc). Depending on your pump, most require a power outlet. There are lots of other amenities that make things easier, but they aren’t a requirement. The “nice to have” items would be:

  • a door that locks or latches shut
  • a fridge
  • a sink to wash pump parts

Talking to supervisors about pumping.

This was really hard for me as a third-year student. Most of the residents that I worked with had no concept of what breast pumping was like. It was hard to strike a balance between getting what I needed and not seeming like I was trying to get out of working. I found it was important to be polite, but firm, and to take the initiative. On the first day of the rotation, I would usually say something to my supervising resident. It usually went something like this:

Hi! I’m really looking forward to the rotation. I just wanted to touch base with you about something. I have a xx-month old at home and I am pumping for her. I’ll need to duck out and pump for about 15 minutes every 4 hours. What are the best times for me to go pump? Can you think of a place where I could go?

Note that I’m not asking for permission to pump. I need to pump – that is not negotiable. Frequency and duration are not negotiable. If it takes you 30 minutes then it takes 30 minutes. What is negotiable is when and where. For example, during one of my rotations there was a break in activity from 8:30-9am, and another from 1-1:30pm. I couldn’t make it all the way from arriving at 6:30am to the 1pm break, but I could pump at 8:30 and then make it to 1pm.

Know what is and is not negotiable, and stand firm if you have to. If someone makes a real stink about it your need to pump, politely take it up the chain. Most female attendings will advocate for students who need to pump. If you get nowhere with your residents, tell your attending that you need to pump and you are worried about how you are going to fit it in while still doing well on the rotation. They can help you. Be as flexible as possible, and make it clear that your work is a priority, but you aren’t willing to compromise your child’s health.

What should be in my pumping bag?

Consider that you may find yourself pumping in a less-than-ideal spot, like a call room or an empty office. You might not have immediate access to a fridge or a sink. Be prepared for that, and pack ahead. I kept a few essentials in my bag just in case. I am including Amazon links, because Prime is my best friend.

  • Pump cleaning wipes (these Medela ones are popular, the Munchkin ones are cheaper but smaller, and the Tommee Tippee version is about the same). These let you clean your pump parts quickly and without a sink.
  • Hands-free pumping bra. I had this Medela one, which runs about $25. It allowed me to write notes, read, etc., while pumping, so it wasn’t “wasted” time. The other option that worked really well for me later in the process was to wear balconette-style bras and just tuck the horns of the breast pump into the cups of the bra. The pump horns stayed put just fine, I felt well-supported during the day, and the balconette style allowed plenty of room for fluctuating breast size throughout the day. Here is an example of the style of bra that I’m talking about.
  • Marker, paper, and tape. Sometimes the door doesn’t lock or latch, and you need to put up a sign that says something like “do not disturb” or “occupied” to keep people from wandering in.
  • Storage plan. Expect not to have a fridge. Bring a lunch bag with ice packs to keep your milk cool. If you’re only working 8 hours, you might be able to store at room temperature. The CDC says you can safely store milk at room temperature for 6-8 hours! So if you work an 8-hour shift and you pump once halfway through, room temperature might be ok. Bring enough bottles or bags (I used these bags) to store the milk you expect to pump, plus a little extra just in case. I also liked to pump into big bottles – I got an adapter so I could pump directly into Avent bottles and bought the 11-oz bottles. When my daughter was about 6 months old, I was sometimes pumping 16oz in a single session, so it was important to have big bottles so I didn’t have to stop and switch out the bottles halfway through my pumping session. You would hate to have to dump that precious milk because you didn’t bring enough bags!

Most importantly, remember that breast milk is a wonderful gift for your child, and that the months of pumping, while they seem to be taking forever, will be gone before you know it. Hang in there!

Other resources:

  • KellyMom – This website was a real sanity saver for me!
  • LactMed – An NIH website and free mobile app with information about breastfeeding and medications. I LOVE this app and use it to advise my own patients.
  • CDC Breast Milk Handling Guidelines – Basic, unbiased information on breast milk storage and handling

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4 comments

  • Catherine Bui

    Hello,
    I read your forum on mommd.com and am trying to get some insight into my upcoming STEP 1. I am due in late August, and so I’m debating on whether to take my STEP at the beginning of August, or take it after delivery in October/November and figure out the breastfeeding then. This is my first pregnancy, and I will be living alone all the way until the last 2 months of pregnancy due to my boyfriend/family living in a different city. I honestly hope to hear from you soon.

    All the best,
    Catherine

    • Indy (admin)

      Catherine,

      Thanks for the comment! First of all, congratulations! This is going to be a long response, so forgive me, but I want to give you a complete answer.

      What arrangements have you made with your school? How soon do you need to start your clerkships? Will you have a lot of help after the baby is born? How anxious would you be about going into labor during your test?

      Keep in mind that a delivery is considered to be term if you deliver between 37 and 42 weeks (though most OBs won’t let you go past 41-41.5). So if you are due in late August, you could deliver any time from early August to early September, if all goes well. If there are any complications in the pregnancy, you might deliver even earlier than that, so scheduling the exam close to your due date is risky.

      I would suggest taking the test either before 36 weeks pregnant or at least 8 weeks after delivery. There are new rules in place which give you extra break time to pump (I posted an update about this a few weeks ago, here), so pumping during the test isn’t as big a deal, but you want to make sure you can comfortably sit in an uncomfortable chair for several hours.

      If you post back with the answers to those questions, I’ll try to give you a less wishy-washy answer 🙂

      Thanks again,

      Indy

  • onedayOB

    Just came across your blog and it’s great to hear someone talk about pumping in third year! I just finished up my third year, and have a 2 month old. I am going to be taking my CS soon, and that is my next challenge. I enjoyed reading about your experience and tips! Thanks!

    • Indy (admin)

      I’m so glad it was helpful to you! The great thing about CS is that it’s pretty short, and you get breaks. My daughter wasn’t nursing often by the time I took CS so I just nursed before and after (I think the test itself was something like 7:30am to 3:30pm). They give you a pretty generous lunch break, so I would expect that you could pump during lunch without any trouble. Remember, though, that the whole CS testing area is a secure area, so unless things have changed significantly, you will need a personal item exemption in order to access your pump during lunch. Good luck!

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