Opportunities to Overcome Barriers to Lactation-Recommendations for Best Practices

Women represent over 50% of graduating medical students in the United States and approximately 20% of current neurosurgical residents in training. An increase in female representation requires an increase in advocacy efforts related to pregnancy. Although there is extensive literature on pregnancy in neurosurgical residents, the postpartum period, sometimes referred to as the "fourth trimester", is frequently overlooked. This study was performed in order to characterize the lactation experiences of female neurosurgeons and neurosurgical trainees and compare their experiences to their peers in other medical specialties.

A 62-question survey examining lactation experiences was developed and electronically disseminated to members of Women In Neurosurgery, the social media group Dr. MILK, and to neurosurgical residency Program Directors throughout the United States.

Seventy-eight responses were received (neurosurgery: 10, other surgical specialty: 19, nonsurgical specialty: 49). When asked if respondents met their goal for lactation duration, 26 nonsurgical, 13 other surgical, and 8 neurosurgery respondents responded affirmatively (p = 0.059). A significantly greater proportion of neurosurgery respondents reported that expression of breastmilk at work caused anxiety compared to nonsurgical respondents (p = 0.02). Overall, 59% of respondents felt that they did not have adequate time to express breastmilk at work, and 69% had to stop expressing breastmilk at work prior to completely emptying. Fifty-three percent of respondents were fearful of being unable to feed their baby secondary to the inability to express breastmilk. Twenty percent reported never being able to consume sufficient liquid at work, and 17% reported never being able to consume sufficient calories at work. Additional cited barriers included limited mentorship (68%), inconvenient lactation spaces (58%), perceived discrimination (32%), and breast pump malfunction (28%).

Women residents across medical specialties face significant barriers to successful lactation experiences. With limited mentorship in lactation across medical specialties, advocacy efforts and lactation support are vitally needed for the protection of the health of physician mother and baby.