Wednesday, September 15, 2010

MiM Mailbag: Pumping intern

Hi there,

I'm glad I found this blog. I have learned a lot from the posts, and I suppose I'd like to ask everyone's advice if that's okay.

I am working as an intern next year in Melbourne, Australia, and my baby will be 8 months when I start. I am planning to continue breastfeeding him. I get some ideas about expressing whilst working but to be honest, I am still very nervous about the whole thing: Will I be able to fit pumping into a hectic internship work? What should I do if I get paged in the middle of pumping session? I have a relatively slow let-down reflex, what if I cannot pump much at work? (I tried manual pump --it's hopeless, havent tried electric one yet though). Which pump should I use --Medela handsfree style or just normal one? (can you actually realistically do some intern works while using freestlyle breastpump?)

If you have some tips or experience to share, I'm all ears :)


-internmama-

24 comments:

  1. I had my baby later in residency...it probably would have been more difficult to pump during intern year. That does not mean it would be impossible, though. Yes, you definitely need a double-electric pump with the ability to be hands-free. You need to get the pump ASAP and start using it so that your letdown reflex is conditioned to the pump, as well as the baby. This may speed up your letdown and will help you pump more in less time.

    My hospital had computerized order entry and EMRs, so if I had a computer where I was pumping I could actually get quite a bit of work done. I never had to stop pumping in the middle of a session because of an emergency with a patient, but I often had to delay a pumping session because of urgent or emergent patient issues. I think that contributed to my supply running low around 8 months and having to supplement with formula.

    Good luck!

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  2. I've had 2 kids and pumped while working as a doc after returning from maternity leave. My aunt, a lactation consultant, recommended this book:

    http://www.amazon.com/Working-without-Weaning-working-breastfeeding/dp/0977226867

    which I thought was very helpful.

    I had a Medela pump in style which was great.

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  3. I wrote a post back in March about pumping at work, and while I'm not sure how valuable it is in itself, the comment thread had some amazing suggestions and tips from readers.

    Definitely need Medela. I used pump in style as well, but there might be a newer better model as my kids are now 7 and 5.

    Good luck starting at 8 months - I found that when my kids were getting good at solids was when my supply started to dwindle. But I always went back to work at 8 weeks so maybe I was just exhausted of the effort by then.

    Getting paged in the middle of pumping is kind of like getting paged when you are going to the bathroom. It sucks, but nothing is so emergent that you can't just finish up and get to it. And really, when you think back, it doesn't happen all that often. So don't let that fear inhibit you.

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  4. Formula works really well, and eliminates all these hassles and concerns...

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  5. Also pumped as an attending only and used the Medela pump in style. I did not enjoy pumping. In fact, I really wanted to throw my pump out the window or an elevator shaft after I was done with each one. But worth it!

    I wrote an essay about my experince juggling pumping at work:
    http://www.annals.org/content/148/8/622.extract

    (sorry, couldn't get full text access here.)

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  6. I pumped as a chief resident and again as a fellow -- not a fun experience. Definitely get a good pump. The other important thing is your space -- if you have a decent, nearby, private setup with phone and computer access (my hospital had one moderately conveniently located pumping room, but I had to use a cell and my personal laptop), that helps. It is nice to be able to return a call promptly, or people will think you're slacking. Make sure your supervising residents and any other people you work closely with know where you're going too -- some will be more sympathetic than others, but at least they'll know where you are.

    At 8 months, hopefully your baby is on some solid foods and you won't have to pump more than a couple of times a day. That helps a lot too. I didn't mind it nearly as much at 8 months as I did at 3 months, when the letdown was random and intense and there was more pressure to produce food for the babies.

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  7. I breastfed both kids for a year, my first one during my last year of residency, and my second one during my second year in private practice. One rotation I was on call q4 at the VA, which doesn't have any lactation rooms, and the call rooms were too far away, so I would just pump in the bathroom. You definitely want to invest in a good electric double pump (I used Medela too) and make sure you have a hands free pumping band or bra. I would typically work while I pumped, answering pages, typing my notes, doing orders etc. You just have to make sure to sit pretty sit and upright while you pump so you don't spill any milk. You basically take the time to pump, and it does mean that your team has to be involved. While I was a resident, my intern would often have to go admit patients while I pumped, and then I would catch up afterwards. Pumping is a terrible pain, but it keeps your milk supply up. Talk to your resident on whatever rotation you are on to set expectations and let him/her know your needs. They'll probably be happy to work with you on this.

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  9. I have no idea about pumping as an intern. However I spent a long time as an EP (exclusive pumper) so I'm just going to give my advice on pumping. By an electrical one, and by a nice one like Medela or Ameda, don't mess around with a cheap value version, they won't hold up very long. However you don't need to go out and buy the advertised hands free ones. While I haven't used them myself I've heard that they do not have the power as the other ones, nor do they last as long. I used the regular "hands on" pumps, but I used them hands off. I would adjust my nursing bra to hold up the pump. Once it got pumping the suction would hold long enough that I could snap the nursing bra back up over the pump and it held it in place. Other people have used hair elastics or rubber bands to hold the pump up, this only words if your small chested. There's also numerous hands free pumping bustiers and bras. But like I said I used a normal, double electric pump and a cheap nursing bra and then I'd still have my hands free to do other things.

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  10. In fellowship I pumped in a bathroom. I used the Medela Freestyle which is a light weight pump and has a rechargeable battery. Also, I used an Easy Expressions bustier to hold the pumping apparatus up. It worked really well and I recommend it. If I had a computer near me I could have done some work also (radiologist here). I tried a manual pump and there is no comparison. The electric pump was way easier and faster.

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  11. I'm a third year med student, not an intern but I figured I would give you my experience. My son is older (16 months old when I started clinical rotations) but still nurses like a newborn and it's very important to me that I provide breastmilk for at least 2 years.

    On wards, it wasn't bad at all, I was able to pump every 2-3 hours except for a 4 hour stretch during attending rounds. Granted I'm just a student so I don't get paged or called for emergent things while pumping, but I think that depends on what specialty you are doing. I've only done internal medicine but really there isn't much in internal medicine that can't wait 5-10 minutes. If it can't wait, then you stop and get back to pumping when you have a chance. No different than if you were eating lunch or going to the bathroom or whatever when you get paged. When my team was on call I would always be unsure when I would get called to see a new admission. On those days, I'd make an effort to pump every 2 hours. Then even if I got called right at the 2 hour mark, then I'd still be able to go pump around the 3 hour mark.

    On clinic it is a little tougher as we are usually running behind anyway, so I haven't wanted to take the extra time to pump. I have clinic just in the morning so I just plan to go from 8-12 without pumping and my body has adjusted. Obviously because my baby is older and does eat other food I'm not as concerned about my supply. It really has not been an issue, though and I'm still producing as much daily as I was when I first started my rotations 3 months ago.

    I've been pleasantly surprised by how supportive everyone has been. No one has batted an eye that I need to take a break occasionally to pump, even for an older baby. I don't think you'll have much trouble! Definitely invest in a good pump (the Medela Pump in Style is great, I've tried the Freestyle too but definitely prefer the Pump in Style) or see if your hospital has a hospital-grade pump you can use.

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  12. I went back to work after 4 weeks of maternity leave as an intern in pediatrics--ended up pumping for 11 months. My biggest problem was having any degree of control over my days--I was never able to pump as much as often as I liked. Would echo the need to get a Medela or find access to a hospital-grade pump (at my hospital, there were several lactation rooms available). I also invested in a rental pump for home so I could pump early in the morning before going to work without waking the baby, because if that happened, I was destined to be late. With luck, you will be through the days of painful engorgement if you can't pump as often as you like. Good luck!

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  13. Agree with Freestyle (no need to plug in, which is great!) and Easy Expressions pump bra. I pumped exclusively, so they were wonderful! I am an ICU fellow, but never ran into having to stop pumping (and I had to pump for 20m each session to empty), but there were certainly times that I couldn't leave to pump because of a sick patient. You just hope that doesn't happen so frequently to decrease your supply.

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  14. I'm a surgery chief resident and it's tough to pump but doable at work. Sometimes work comes before pumping and I can only pump in 6hrs due to surgery case and other times every 3-4hrs. I recommend freestyle. I pump wearing a large scrub top sitting at a computer and writing my notes. I can answer pages, emails, and call patients at the same time. There is never a situation as an intern that can not wait usually 10minutes to pump. I've also pumped driving to and from work as well. When there's traffic, I don't mind cause I'm pumping at the same time so feel like it is not time wasted. Get a good hands free breast pump bra. It takes 20minutes max to pump but usually if in a hurry 10minutes will do. Goodluck. Your baby will appreciate the effort. Don't be discourage if some days you get less milk. I pump during the night as well when my baby does not need it to get an extra bottle on hand.

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  15. I went back as an attending at 5.5 months and pumped until 13 months. Most of my tips have been covered, but I will add:
    I joined a pumping moms support group on Yahoo - hugely helpful with tips, etc.
    I didn't need a special bra - I figured out a way to make my nursing bra work - allowed hands free pumping, so I got work done.
    I fed on one side and pumped on the other in the morning - this got me one full feed (I was lucky to have a good supply) and then I only had to pump once more at work. I still pumped at least once on weekends or non-work days, to build up a freezer stash (and I started before hand too).
    Oatmeal helped my supply when I was sick/run-down/etc.
    I had a Medela Pump In Style and made sure I had batteries if needed.
    The acute care hospital in our district (not where I work, though) lets residents use the NICU pumping room, if needed. Might be worth asking?
    Good luck! You'll be pretty close to being able to use cow's milk or other during the day (depending on which guidelines you believe in! :)) so that might help - in the end, we delayed dairy due to some allergy concerns until 13 months, but once he was good with that, I day-weaned him and continued nursing 3 times a day - he gradually self-weaned with our last session at 22 months... sad for me, but satisfying too. I still miss it!

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  16. Thank you all for the great advice. and I visited your post back in March, Gizabeth. Great help. I'll definitely talk to the lactation consultant and research about pumping facilities in the hospital. And I guess I just have to be confident that it can be done and throw away the fears that things might not sail smoothly.

    Sounds like everyone's happy with Medela pump in style. Has anyone had experience with Ameda Purely Yours?

    Also, some other questions:
    1. How did you tell your team about your need to pump? How and when did you approach your team (intern/resident)? What arrangement did you make? And did you tell your consultant at all (If you're not one)?
    2. Where do you store your milk? do you bring a cooling bag or borrow a fridge from hospital?

    Thank you again! Many many BIG BIG thanks!!!

    -internmama-

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  17. Sorry I'm chiming in late here, but it's absolutely possible. I had 2 kids during a busy fellowship and a 3rd during the first couple years of my first "real" doctor job. We never used a single bit of formula. I would add my voice to the chorus of support for the Medela. I had a Pump in Style with my first two and a Pump in Style Advanced (has a better letdown feature) with my third after wearing out my original! I thought the Advanced was well worth the money, far cheaper than buying formula, and will likely be for you as well if you pump for even a few mos. All the more true if you plan to have more kids and use it again. You can do some work while pumping. I had a complicated Medela bra with rubberbands and these plastic connectors and whatnot with my first. With my second, I used the Easy Expression Bustier. With my third, I just kind of took my left hand/forearm and held both of the breast shields in place. As you have more kids, you find you need fewer gadgets, but if you're not comfortable being totally gadget free, I'd recommend the bustier. To build up your supply and your store of milk before you start internship, I'd highly recommend pumping on one side while the baby nurses on the other, once or twice a day, ideally in early am when milk supply is highest or during the night if your baby still nurses at night. Your body will produce more milk at those times (and generally) as it will be "tricked" into thinking you are nursing twins. You will also be able to store a ton of milk up in advance. Doing this, I literally had so much breastmilk we couldn't use in my freezer that I donated quite a bit to a milk bank and discarded hundreds of ounces too old for them to accept. The good news is that an 8+ month old will be eating more and more things other than breastmilk, so you shouldn't need to pump more than twice in a regular, non-call day. Breastmilk has antimicrobial properties and can be stored for 8 hrs at room temp, but if you will be away longer than 8 hrs, I'd bring an insulated bag with ice packs. Pumping and breastfeeding are happily common now, so I'd just be positive and matter of fact about it. I don't think anyone will bat an eye.

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  18. Sorry I'm chiming in late here, but it's absolutely possible. I had 2 kids during a busy fellowship and a 3rd during the first couple years of my first "real" doctor job. We never used a single bit of formula. I would add my voice to the chorus of support for the Medela. I had a Pump in Style with my first two and a Pump in Style Advanced (has a better letdown feature) with my third after wearing out my original! I thought the Advanced was well worth the money, far cheaper than buying formula, and will likely be for you as well if you pump for even a few mos. All the more true if you plan to have more kids and use it again. You can do some work while pumping. I had a complicated Medela bra with rubberbands and these plastic connectors and whatnot with my first. With my second, I used the Easy Expression Bustier. With my third, I just kind of took my left hand/forearm and held both of the breast shields in place. As you have more kids, you find you need fewer gadgets, but if you're not comfortable being totally gadget free, I'd recommend the bustier. To build up your supply and your store of milk before you start internship, I'd highly recommend pumping on one side while the baby nurses on the other, once or twice a day, ideally in early am when milk supply is highest or during the night if your baby still nurses at night. Your body will produce more milk at those times (and generally) as it will be "tricked" into thinking you are nursing twins. You will also be able to store a ton of milk up in advance. Doing this, I literally had so much breastmilk we couldn't use in my freezer that I donated quite a bit to a milk bank and discarded hundreds of ounces too old for them to accept. The good news is that an 8+ month old will be eating more and more things other than breastmilk, so you shouldn't need to pump more than twice in a regular, non-call day. Breastmilk has antimicrobial properties and can be stored for 8 hrs at room temp, but if you will be away longer than 8 hrs, I'd bring an insulated bag with ice packs. Pumping and breastfeeding are happily common now, so I'd just be positive and matter of fact about it. I don't think anyone will bat an eye.

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  19. Sorry I'm chiming in late here, but it's absolutely possible. I had 2 kids during a busy fellowship and a 3rd during the first couple years of my first "real" doctor job. We never used a single bit of formula. I would add my voice to the chorus of support for the Medela. I had a Pump in Style with my first two and a Pump in Style Advanced (has a better letdown feature) with my third after wearing out my original! I thought the Advanced was well worth the money, far cheaper than buying formula, and will likely be for you as well if you pump for even a few mos. All the more true if you plan to have more kids and use it again. You can do some work while pumping. I had a complicated Medela bra with rubberbands and these plastic connectors and whatnot with my first. With my second, I used the Easy Expression Bustier. With my third, I just kind of took my left hand/forearm and held both of the breast shields in place. As you have more kids, you find you need fewer gadgets, but if you're not comfortable being totally gadget free, I'd recommend the bustier. To build up your supply and your store of milk before you start internship, I'd highly recommend pumping on one side while the baby nurses on the other, once or twice a day, ideally in early am when milk supply is highest or during the night if your baby still nurses at night. Your body will produce more milk at those times (and generally) as it will be "tricked" into thinking you are nursing twins. You will also be able to store a ton of milk up in advance. Doing this, I literally had so much breastmilk we couldn't use in my freezer that I donated quite a bit to a milk bank and discarded hundreds of ounces too old for them to accept. The good news is that an 8+ month old will be eating more and more things other than breastmilk, so you shouldn't need to pump more than twice in a regular, non-call day. Breastmilk has antimicrobial properties and can be stored for 8 hrs at room temp, but if you will be away longer than 8 hrs, I'd bring an insulated bag with ice packs. Pumping and breastfeeding are happily common now, so I'd just be positive and matter of fact about it. I don't think anyone will bat an eye.

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  20. I started my family medicine internship last year with an 11 month old, still frequently breastfeeding baby, and pumped for that first month of internship, as well as pumping for large parts of my 4th year of med school. A few helpful things:
    -the Medela Freestyle pump is fantastic, and I usually paired it with one of the bustier thingies, which was quicker to set up than using the Freestyle's nursing bra attachments
    -I was able to do some computer or written work while pumping, and the pump isn't so loud that you couldn't return phone calls
    -stored my milk in the fridge in the resident room, then carried it home in a cooler bag. During some rotations, my husband was able to bring our daughter in at dinnertime or bedtime for me to nurse, and I would sometimes swap out bottles with him at that point if I was on a 30 hour call
    -I 100% agree with the above comment about just being matter of fact about it...I would just say to the supervising resident or attending that I am a breastfeeding mom, and I need to pump about every x # of hours, and could they suggest good times to fit that in around the work that needs to be done. Admittedly am in a VERY family friendly residency where my seniors would take my pager and shoo me off to pump, but I didn't get any grief on my rotations in med school, either. On my subinternship, I would pump or nurse right before I left home, then pump between prerounding and rounding, either right before or right after noon conference, and then would just work around admissions for the evening/overnight hours. (It was a pedi sub-I, so I was often not the only person on the service who was doing this!)
    Good luck! I stopped pumping when my daughter was a year old, but she is now two and still nursing once or twice a day, and we both still love that little pocket of time together.

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  21. Internmama - I would just tell your resident and intern right off the bat that you need to pump every 2-4 hours, and work out a schedule with them. I don't think it's necessary to tell the attending if it won't affect rounds. I don't think you'll have problems, because breastfeeding is pretty common among students/residents, etc.
    Storage - bring a cooler bag with ice packs. If I had to be on call overnight I would put the milk in the freezer. There's usually a resident lounge somewhere with a freezer for food, and just store it in the cooler bag to avoid any ick factor from your colleagues.

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  22. you can pump while feeding now and store up a lot of frozen feedings. When my kids were eight months, I didn't need to pump at work--just breastfed them when I was home. If I had been taking overnight call, I would have pumped at work during the nights, but otherwise it may not be necessary.

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  23. I went full time Aussie internship (60hoursish) when my daughter was 9 months, I worked part time until then from 4 months.
    I think at 8 months you could pump less, the bub will be on solids. Before you start build up a frozen supply while you're in your own home. Then if you pump to keep your supply up rather than to try and feed your baby the milk it will take the pressure off.
    I couldn't pump very well at all but my daughter had EBM til 6 months and often formula for one feed a day after that

    Remember its not all or nothing. AT about 1 year I started doing morning and night feeds and kept doing them til my daughter was 2, it was a very special time.

    Now my son is 6 months, pumping is so hard with 2 so I didn't. I usually only miss one feed in a days work, I feed before I leave, he has 3 solids and one milk feed while I;m gone and I feed as soon as i get home and before he goes to bed.

    a mixture works well.
    Make sure your plans are flexible and see how you go
    If you want to contact me about anything else feel free bekleds@yahoo.com.au

    I have fought most of the fights of being a mum in medicine in Australia in the NT, SA and WA so would be happy to help. I also have a Dr Mum (my best friend) in Melbourne.

    Good luck

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  24. I'm 4 months into residency with a still-nursing 1yo. I didn't expect to be able to pump, but my daughter really really loves nursing... and so do I... and it hasn't been nearly as hard as I expected.

    I'm in the US, so I've been working 70-80h weeks so far, including 30h shifts. Here's what I've done/found:

    1) I tell my team on the first day I work with them, generally towards the end of initial introductions (as an "oh, by the way..." aside) or the next time we touch base, depending on how busy we are. I phrase it as "I have a nursing baby, so I have to pump from time to time." No "will it work for me to...?" phrasing here! I haven't had any bad reactions yet.

    2) I have a medela pump in style pump and a pumpin-pal hands-free strap. This lets me work at a computer, talk on the phone, write notes... or all three at once while pumping.

    3) I've done the vast majority of my pumping in call rooms, since here at least they're generally equipped with: a chair, a table, a computer with access to patient records, an in-house phone, an electrical outlet, and a lock. In other words, they're totally perfect. I write notes, answer pages, whatever I need to. The only time it really costs me is setup/clean up time - not bad, really! I'm also kind of a slow pumper - but that's fine, since the actual pumping time is productive time for me.

    The only thing you can't do is run go see a patient. It hasn't been a problem yet - there's never been a page while I'm pumping so urgent that showing up in 15 minutes wasn't fine. If it happened, I could stop, put my shirt down, and run out the door to come back and clean up later. Not a big deal.

    So, overall: it's been fine, not nearly as hard as I expected, and totally worth it! Take heart!

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