Pumping possibilities: A full-time trainee experience breast pumping at work

By Sophie Gatfield
Trauma and Orthopaedic ST5 Trainee, Severn Deanery

Breast pumping. For some, an integral part of sustaining a child in their early life. For most, a vague comprehension of a process involving loud, clunky, vacuum pumps in locked rooms. You may have opened this article with an interested breastfeeding your own child, or on behalf of a partner or friend. Or you may have a colleague or trainee who is looking to pump at work and has come to you for support. With the increase in the diversity of our workforce and flexibility in the ways we work, breastfeeding and pumping issues will be relevant for all of us in the coming years so read on and find out more.

My story

When I was pregnant, I knew I wanted to try to breast feed if possible. I also knew that I was planning to return to work before my son was six months old and therefore pumping at work would need to become something to get my head around. I had no idea how it would all work and whether it would even be possible. Although increasing numbers of orthopaedic trainees are female and with young families, I could find very few of my colleagues that had successfully pumped after returning and none that had gone back before their child was six months old. Nevertheless, I was determined to try. A year later, I am proud to have managed to pump and feed by son on exclusive breast milk until six months, continuing in combination with solid food and formula to over 12 months. This article is intended to share what worked for me, demonstrate what may be possible for others and hopefully prevent any female surgeons from feeling pressured to stop breastfeeding when they return to work.

What is breast pumping and why does it matter?

It is clearly established that breast milk is the best milk for early life¹ and breast feeding an infant also carries other benefits such as bonding, transfer of antibodies, reduced breast cancer risk for mothers. Breast milk is also free, sterile and the ideal temperature. WHO recommends frequent, on demand breast feeding until two years of age or beyond². Infants can only be given cows milk or plant based milk as their main drink above one year of age³. For working mothers, breast pumps can prolong the period that they can provide breast milk and support them to continue direct breast feeding at times when they together are with their baby. For others who have been unable to breastfeed directly, pumping can enable provision of breast milk throughout infancy.

Breast pumps are the most common method of expressing breast milk for infant feeding and this may be given via syringe, bottle or cup depending on the age of the child. Breast pumps historically are noisy, complicated contraptions that require a woman to be ‘plugged in’ to an electricity supply, fully exposed and often holding the pumps against their body for 20 or 30 minutes per pumping session, leaving little room for flexibility or practicality. More recently battery powered, portable and hands-free pump options have transformed the process of pumping for women.

What are you entitled to?

In the UK all employers are required to provide a safe working environment, adequate rest facilities and protection from indirect sex discrimination. This translates to undertaking a risk assessment and making adjustments to your specific role in order to support your health and this may involve changes to your working hours or responsibilities without a change in pay⁴.

The BOA have produced specific guidance targeted at parents in Trauma and Orthopaedics that helps to decode the murky world of employment law, what is legally your right and what is practically and feasibly possible:

www.boa.ac.uk/careers-in-t-o/parenthood-orthopaedics/return-to-work.html

In summary, you should be offered appropriate breaks, milk storage facilities and a private space (other than a relatives room or toilet!). While this may be straightforward in some places, we have all worked in ancient buildings where the rest facilites all feel like an afterthought and/or are miles away from your working locations. Therefore, actively considering what you personally feel comfortable with and engaging with supervisors/managers to work out what is right for your specific circumstances is essential.

Who can help?

In your trust:

• An Educational supervisor
• A SupporTT champion
• A Wellbeing lead
• An Infant feeding team – may know about generic facilites in your hospital sites. In some circumstances have access to hospital grade pumps!
• Other national sources of advice: See external resources below.

My top tips for pumping at work

1. Tell people – All colleagues I worked with while pumping were supportive and understanding. No one wants you to be stood in theatre gradually soaking through your scrubs because you don’t want to make anyone feel uncomfortable. Equally, sudden changes in your breast feeding/pumping habits can prove a genuine health risk in the form of mastitis, blocked ducts and breast abscesses. Your colleagues will rather support you to maintain safe regular pumping sessions than have an extended period of sick leave.
2. Plan ahead – look at your sessions and consider when good pumping slots would work. I used to identify work that I could do while pumping which made me feel more confident to excuse myself - for example - 'I’m just going to do the X-ray requests for the afternoon clinic upstairs for 20 minutes'. Several times I would be assisting in a long case. However, ensuring that my trainer was aware that I would need a break before the case started meant that this could be timed at an appropriate place or an additional assistant could be arranged.
3. Get to know your boobs, your pumps and your babies preferences – there is a lot going on in the first few months after your baby is born. However, if you possibly can, the earlier you think about pumps and bottles the better. Not all babies like all bottles and not all breasts like all pumps. There are a lot of variables to play with and timing introduction of a bottle and starting to express milk will be personal to you and your baby. I tried several different pumps but for me the gamechanger was a hands free and portable pump so that I could be flexible about where I pumped and could do bits of work as needed while pumping. I bought them two months before returning to work and used them most days so I got really used to how they work, how to clean them and how to store milk.
4. Get a good bag – I used a lunchbox sized cool bag with a freezer pack slot. This was big enough to keep all pump parts and 3-4 bags of milk cool and fit on a standard fridge shelf. Keeping everything together in one place to slot in and out of the fridge made it easier for me to store without worrying about someone’s smelly lunch dripping into my pump parts!
5. Use your KIT days as recce missions and practice runs! – A large percentage of my first KIT day was identifying all the fridges and lockable doors near to my areas of clinical practice. Using supranumery time to trial pumping sessions and locations is invaluable!
6. Don’t be afraid to ask for help – This may be something as simple jumping up a waiting list for your own locker to store your pumps or for more extended time off an on call rota but whatever it is, people won’t necessarily be aware of what they can do to help so ask!
7. Consider building a stash – I stored about 6L of pumped milk so that there would be some in reserve for that inevitable time you leave the pumped milk in the fridge or the bag splits. Some days I would pump less than others and so having a store took the stress away. Freezer milk can be stored for up to six months and defrosted very quickly. Be careful about pumping too much extra in one go at the beginning as this can stimulate oversupply. 50-100mls per day extra should be enough to build up a bit in reserve without risking oversupply.
8. Have a Plan B – For me pumping at work felt manageable and sustainable and as long as it did, I kept going. However, I promised myself that if the balance tipped I would consciously wean down.
9. Geography is important! – I found that location of my pumps and fridge were more important than having a private room to pump.
10. You don’t need to clean your pumps every session – I stored my pump parts in a clean tray inside the cool bag in the fridge. I would then clean once a day in hot soapy water at home and leave to air dry overnight.

A final word

These tips are all personal to me and are by no means intended to read as a ‘how to guide’.  Breastfeeding is a personal journey and everyone’s experience is different. But if one person reads this and realises what may be possible then writing this article will be time well spent!

External resources

References

1. Victora CG, Bahl R, Barros AJD, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016;387(10017):475-90.
2. WHO (2021). Infant and young child feeding. Available at: www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding.
3. NHS (2023). What to feed young children. Available at: www.nhs.uk/conditions/baby/weaning-and-feeding/what-to-feed-young-children.
4. Maternity action (2023). Continuing to Breastfeed when you return to work. Available at: https://maternityaction.org.uk/advice/continuing-to-breastfeed-when-you-return-to-work.