Friday, December 30, 2011

Guest post: Being a nursing mom on the residency interview road

Editor's note: For companion reading, see my op-ed column "America, get over breastfeeding hangups" from Tuesday's USA TODAY.

I have been blessed to be on maternity-leave since 3 weeks before my due date. My days as a new mommy consist of nursing, diaper changes, cuddling, singing, reading, video chat dates with my distant new mommy friends, sending daily pictures and and videos to my husband and Lil Zo's grandparents, and phone calls with my family. Similar to most other mothers, I chose breastfeeding as the method of feeding our baby in the prenatal period. I knew it was the best thing for Lil Zo, but after consulting several breastfeeding friends, I also knew that it would have its challenges. Thankfully, I delivered at a breastfeeding-friendly hospital and Lil Zo nursed successfully within minutes of our natural delivery. The feeling was bittersweet, I was excited that he’d latched but it was uncomfortable. His latch was perfect but it still hurt for at least a week as my nipples became accustomed to his vigorous sucking. In the neonatal period, he lost a few ounces, but quickly regained them with on-demand (often hourly) nursing for his first few weeks (I am soo glad that phase is over, growth spurts are an entirely other issue).

Now, at 11 weeks old, he and I have had a great time getting into our rhythm and he has even begun taking an occasional bottle from my husband when I am out running errands. Interview season threw a wrench in our well-oiled machine.  The weeks before my interviews began, I looked at my freezer milk stock and began to freak out. How much milk would he need? What would happen if I had to supplement? Would his sitter understand how to prepare the milk? After consulting a very nice woman with the La Leche League, I knew how much milk he would probably need. Thankfully, my family has been able to watch him and I haven’t had to rely on strangers.

Based upon the wonderful advice of the Pediatric Clerkship Coordinator at my home institution, I called each of my interview locations 3 weeks prior to my interviews to inquire about pumping facilities. Pediatrics is awesome!!! Everyone was very helpful and my worries about being a bother were quickly dismissed.  Thankfully my furthest interview was only 4 hours away and my husband was able to accompany me. Armed with my handy Medela Pump in Style and my briefcase, I began each day discussing pumping times with the interview coordinators. Although I wasn’t able to pump every 3 hours as is recommended, I was able to pump in the car on the way to and from the interviews, once in the morning, and once in the afternoon. My time pumping was also a nice chance to reflect on my interview day and have a brief break from smiling incessantly and coming up with impromptu questions. Thankfully, Lil Zo didn’t require any formula and remains an exclusively breastfed baby.

In my humble opinion, UNC Chapel Hill had the best pumping facilities. The Resident Call Suite provided a private room with comfortable chairs, a desk, and a sink. It was nice to be somewhat removed from the main interview location and to not have the Residency Director on the opposite side of a thin wall.  I am indebted to the many Attendings that I affectionately referred to as my “Pumping Godmothers” (note: I did this in my head and would never, ever tell them) who let me know that they too had had to pump during interviews, training, and now daily as they provided the optimal nutrition to their newborns.

Now that I’ve completed my first full days of pumping, I realize how difficult it must be for full-time working mothers especially during residency. What has your experience been? Are there any breastfeeding medical students, residents, or attendings who were able to exclusively breastfeed through the 1 year mark?

Mommabee is an upperclass Medical Student at a mid-Atlantic medical school who is interested in community-based Pediatrics and has a background in public health. Lil Zo is her first child.


  1. Pediatrics is definitely awesome in that way. I had my second baby in my third year of residency, started fellowship immediately after residency. I have to say subspecialities are not as nursing friendly but I was able to pump till my daughter was almost 9 months old. She remained exclusively BF till 8 months of age.

  2. I am now a third year Internal medicine resident. I had a 4 month old baby when I was on the interview trail 3 years ago and carried my Pump in Style along, Fed-Exing breast milk back home when my baby did not come with me. (she came with on half the trips). I breastfed my first daugther until she was 2. My second baby is now 6 months old and I am breastfeeding her and pumping too. Feel free to PM me!

  3. I breastfed both my girls for 14 mos each. The first was born during the preclinical years, so I had more control over my schedule. I took a leave of absence with the second. When I returned to clinical work both times, I did have a hard time finding the time and space to pump. I would have loved to have nursed my girls for longer, but the clinical months killed my (rather sensitive) supply. At any rate, I was happy I got to breastfeed as long as I did.

    I don't know if you all have seen this, but here's an article about a case in the Massachusetts courts challenging the NBME's policy that women cannot have extra time to pump during board exams.

  4. Congrats on making it work! I had my first fellowship interview when my baby was 21 days old - and we (my husband came with me) to fly in order to get there. I think you were fortunate - I pumped in stranger's offices. The people (almost all men) that I interviewed with did not know where I was during "break" periods of the day, it was mostly the secretaries who arranged the private time/space for me. Honestly, I wasn't comfortable bringing much attention to it, which made the whole situation feel even more awkward. A bit of extra fun was when one of the other applicants asked my why I was carrying around so many bags.

    In regards to how my baby did, we had done a trial run with a low flow bottle two days before and THANK GOD she was willing take the bottle and still nurse. She did get formula while I was interviewing as the interview day was almost 7 hours and we were traveling without any way to keep a store supply of milk.

    In regards to your other question - I found pumping at work extremely difficult. I didn't have an office and the "pumping room" was actually the storage closet where the PTs kept their equipment. I made it six months and was very very proud to have done so. My policy, and I know this is the subjective of sometimes much heated debate, is NO GUILT when it comes to BF. If you can make it work, great. If not, your baby will be fine. I am pregnant with my second and fully intend to BF again, but if I don't make it 12 months (or even the 6 I did with my daughter, I am not going to lose sleep over it. There are far too many other things to lose sleep over!

  5. I think the guilt comment above is right on. I was devastated the first time I bought a can of formula to supplement the ounce an hour I was struggling to maintain while working. I breastfed baby #1 through 2nd year of med school, and baby #2 through the end of 4th year and then through most of intern year. Just before baby #2 was born, I made a deal with myself that I was going to enjoy nursing and do my best but that I wasn't allowed to feel bad for having to supplement an ounce or two a day. I'm now getting ready to have our last babe at the end of residency in June (yes, there is an end to residency - wahoo!) and hope to take some time off before getting a real job.

    I am proud and grateful I was able to nurse over a year with each baby, even if doing so at times required supplementing with formula.

    So - no, I did not successfully "exclusively" breastfeed in med school or residency. But I did my best and "exclusive" or not, I was glad to be able to continue my nursing relationship with each of my babies. It's not easy, (even when it's not exclusive) but it is possible to nurse babies throughout the spectrum of medical training (although I'll have to get back to you on that whole attending level thing).

  6. I'm a 4th year vet student, and my 6-month old son is exclusively breastfed. There are no pumping facilities in the hospital as far as I know, so I use the handicapped stall in the bathroom. I definitely don't get to pump NEARLY as often as I'd like - I'm currently on my second pump of the day and I've been at work for 12.5 hours - but luckily I started pumping when H was only a week old, so at the peak I had about 600 oz in the freezer. We're blowing through that stash now, but I'm still hoping to make it to a year of EBF. I used every minute of break time during the board exam to pump, and I'll continue pumping in the bathroom - and probably FedEx milk home - when I start externships in a few weeks. It IS a giant pain in the ass, and I know some of the clinicians think I'm slacking off when they can't find me for 20' while everyone else is rushing around crazily with patients, but I love breastfeeding H and I think it's 100% worth all the hassle.

  7. See my earlier post:

    I breastfed during residency for a year, exclusively for the first 6 months. Now I'm an attending and hoping to avoid formula with my second, who's 6 months. It's way easier the second time around.

  8. I'm a third year medical student and I breastfed my son until he was over a year old. I pumped throughout clerkships. I was severely penalized on one of them and had nasty comments written on my evaluations about how I should not have been nursing because it took me away from the floor. I continued nursing anyway as I felt it was the best thing I could do for my child. My tips would be: pump early in the morning before you go to work, as you'll carry the most milk at this time. Take many sets of pump parts with you to work so you don't have to spend time washing them. They can go in the dishwasher when you get home. Finally, be proud you're nursing and don't let anyone shame you about it. We absolutely can take good care of our patients while nursing our babies. While I pumped, I would study or write notes. Multitasking helps in this way. Good luck!

  9. Here's some collective wisdom from me and other residents I've talked to:
    - there are A LOT of call rooms in the hospital and probably some nursing rooms in the peds areas of the hospital. Find out where all of these are and use what's close!
    - the NICU often has pump supplies if you're ever in a bind and the hospital has pumps too, a group of nurses in our SICU actually had permission to keep one in the sleep room in the back since a few of them were nursing at a time, maybe you could do this with some residents/nurses and not have to lug the pump back and forth.
    - if you don't have the hands free pump, get the hands free bra thing and pump where there is a computer and you can write notes, orders, etc while pumping.
    - #1: DON'T FEEL GUILTY EVER!!!! Feel proud of doing this for your baby, just do your best, that's all you can do. You're already awesome! I probably started enjoying nursing/pumping more once I finally had to supplement with formula the first time, then I got over my psychotic need to be "exclusive," and I just enjoyed breastfeeding, we're at 13 months and still going!

    Good luck!

  10. I just finished the med school interview process while pumping. Baby was 6.5 weeks old for my first interview. The schools - mostly state schools in the west and one "fancy" private school - were very accomodating. I called ahead to make sure the timing would work. One school even had a pump room with nice tables and chairs. It was the airports that were no fun. I mentioned my baby in each of six interviews .... Have already been accepted at four schools. So it can definitely be done ... At least at this stage of the process.

  11. It is possible, but difficult. I breastfed my first until 8 months (she self-weaned, I would have gone longer) during my 3rd year of residency exclusively. She got only breastmilk until she decided to stop nursing and I happily gave up the pumping. I pumped in the call room and kept my milk in a discreet little cooler inside the resident refrigerator, so as not to disturb other's delicate sensibilities. I did not ask for special time to pump, just took it when I could and tried to plan my days accordingly. I second the suggestion for a hands-free pumping bra - several of them.

    During my first job out of residency, I breastfed my second for about 13 months (he would have nursed forever, I think). I asked for time to be carved out in my scheduled to pump, but it rarely was granted. I pumped in my office while I caught up on charting. I also got to pump on the job interview trail in my share of airport bathrooms, sitting on the toilet in a stall with a battery pack to power the pump. Fun times.

    I barely was able to keep up with his demand, but did not have to supplement with him either, though I would have. I got mastitis twice. I feel lucky that I was able to nurse both of my children, I have had many patients who have had much more difficulty, and I hate the judgement they feel when they are unable to exclusively breastfeed.

  12. I'm not a doctor but a PA in a busy private practice with a one year-old son who still nurses twice a day. I know the electric double pumps are the best but I was a big fan of my manual Medela Harmony pump. It's cheap (less than $40), has only a few pieces, and is a great back up. I found I expressed more manually than with the fancy pump and I ended up using it most often. It didn't take long to set up and I could be mobile with it to let the dog out, answer the phone, etc.

    Although my son is still nursing he was far from exclusively breastfed. I made it about 3 months before supplementing and I kind of wish I had done it earlier. I spent too long calculating how much I had in the freezer and when we would run out. I was rushing home after work to be able to nurse him before he got hungry and needed a bottle. Once I started giving him formula as needed it made life a lot easier. My supply did go down as I supplemented more but it worked for us. Pumping was not my favorite and I give credit to those of you who have made it work especially with the challenges of med school or residency.

  13. My eldest was bottle fed breast milk during his 2 week stay in the NICU and never latched after we were able to bring him home. As a result, I pumped for him until he was 15 months old and he was exclusively breastfed. It was awful to be tethered to the pump that long but I still count myself lucky that I produced well enough with a pump to feed him. I was working in a doctor's office at the time and mostly pumped in the least used exam room.

    With my second child I was back in college finishing my undergrad degree. There were no facilities on campus and no place to store milk so when I had a long enough gap between classes I would have to go back to my car and pump under a blanket (when I first got the pump in style I couldn't figure out why there was a car adapter with it, but that thing really came in handy!).

    It is doable.

  14. Another 4th year (out of 5 years) med student here. Glad to here that residency interviews with baby along (and/or pumping) are possible since I am hoping to be in that position myself!

    I have an 18 month old; she nursed until 15 months. My best tip for med students on the wards/residents is to give the Medela hand pump a chance. It seems crazy, but it frequently made pumping more convenient for me than the pump with hands-free bra. The manual pumps can be disassembled and carried in a white coat pocket, and you can slip into a bathroom and use one without an electrical outlet if you need to. Super convenient since it saves you the time of getting all the way to a pumping room PLUS the time of assembly/disassembly. Washing is easier, too. Also I swear my letdown was faster with the manual pump; I timed it and the pumping itself took exactly the same amount of time as with the electric pump, even though I could only do 1 side at a time. (In other words time for 2 sides with manual pump == time for 2 sides with electric pump). At the very least, keep a manual pump in a locker or somewhere on-site at work, just in case you forget a part for your regular pump one day.

  15. There are great comments here, with terrific advice. The only thing I would like to add is that not all women are created equally in the milk making category. It may not be possible for you to breast feed or to pump without extreme difficulty. Despite best (even heroic) efforts. Certainly your chosen specialty or stage of training may be a factor as well. So most importantly do you best then accept your best as awesome.

  16. Off topic, but I was pleasantly surprised by the comments in the USA Today article you linked to. It's my new year's resolution to not read comments on news sites, but my curiosity got the better of me. People had really supportive things to say.

  17. MedicineAdjacent - I know, reading the comments section on any online news site usually puts me into a low-level depression about humankind. Definitely most supportive comments on a piece on this issue I've seen, and some of those comments/retorts were laugh-out-loud funny.

  18. I, too, am a nursing mom on the interview trail. It is so funny how many people recognize the good old medela PIS bag. I have had teh wonderful experience of a TSA agent turning green with disgust when I informed him I was carrying breastmilk in my bag (I guess he would have preferred a weapon??) and I have had fellow applicants gossip about me while on a pumping break - apparently they thought I had left the interview day! I really love it when they let me use a call room! I have not been as proactive at contacting programs beforehand, I really had no game plan and was very unprepared. But a few programs have let me pump on the fly. Otherwise I end up doing it in the car before I get to the airport.

  19. Another breastfeeding momma on the interview trail here. Well, actually just submitted my rank list, so that makes me DONE with the interviews! I was interviewing in pediatrics, and I was so pleasantly surprised how awesome and accommodating people were with my pumping needs. Everyone recognized the Medela bag ("Oh, you have a baby! My wife has that same bag!") and there was always some place to pump. My daughter is 18 months, and therefore I always felt a bit sheepish when I said I needed to pump. It is obviously not common to be still pumping for your toddler in this country. But my comment about "still breastfeeding" was met by "oh don't you dare be ashamed of that, I nursed my two sons until they were 2.5!" from the program director I was talking to. Amazing.

    So yes, I made it past the 1 year mark. And now I have no idea when it will come to an end. It seems surreal we have even made it this far, we have such a wonderful breastfeeding relationship but it was a VERY rocky start. A lot of the above comments have great advice - pumping on the wards is not always easy. I missed many noon conferences, or walked in late. I made phone calls to radiology or consults from the call room while pumping with a hands free bra. I got really good at just saying, "I need to go pump" even though it was sometimes met with "huh?" It was something that was incredibly important to me, so I found ways to make it happen.

    Great job making it this far, just continue to take it one day at a time :)


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