Résumés
Abstract
Background: Despite known benefits of breastfeeding and challenges medical trainees face lactating at work, research specific to Canadian surgical trainees is lacking. Our objectives were to examine existing breastfeeding and lactation policies, query experiences and opinions of surgical trainees and program directors, and propose a comprehensive policy for programs nation-wide.
Methods: A multi-disciplinary team developed this two-part study. The scoping review used database and grey literature searches to find North American policies covering surgical residents. The survey study queried lactating Canadian surgical trainees and program directors about experiences and barriers, support provided, and interest in a breastfeeding and lactation policy.
Results: Ten policies were found. None comprehensively addressed lactation space and supplies, break times, supports, and resident responsibilities. Among ten PD survey respondents: 60% were female, 70% had lactating trainees during their tenure, 40% discussed lactation accommodations, and all were willing to instate a policy. Among 24 trainees: 45% met breastfeeding goals, 74% stopped breastfeeding prematurely due to work barriers, and 88% had little workplace support. Almost all trainees (96%) wanted a policy.
Conclusion: There is opportunity and appetite for a more comprehensive breastfeeding and lactation policy for Canadian surgical residents. Our policy highlights important areas where trainees can be better supported to meet breastfeeding goals.
Résumé
Contexte : Malgré les avantages bien établis de l'allaitement et les difficultés auxquelles les apprenants en médecine sont confrontés pour allaiter sur leur lieu de travail, il n'existe aucune recherche spécifique qui concerne les apprenants en chirurgie au Canada. Nos objectifs étaient d'examiner les politiques existantes en matière d'allaitement et de lactation, d'interroger les expériences et opinions des apprenants en chirurgie et des directeurs de programmes, et de proposer une politique globale à l'échelle nationale.
Méthodes : Une équipe multidisciplinaire a développé cette étude qui comporte deux parties. L'examen de la portée s’est réalisée à l’aide des bases de données et de la littérature grise pour identifier les politiques nord-américaines relatives aux résidents en chirurgie. L'étude par sondage a permis de recueillir les expériences des apprenants en chirurgie canadiens qui allaitent, ainsi que les avis des directeurs de programmes sur les obstacles rencontrés, le soutien fourni et l'intérêt pour une politique d'allaitement et de lactation.
Résultats : Dix politiques ont été identifiées. Aucune ne couvrait de manière exhaustive les aspects relatifs à l'espace et aux fournitures d'allaitement, aux temps de pause, aux soutiens, et aux responsabilités des résidents. Parmi les dix directeurs de programmes ayant répondu au sondage : 60 % étaient des femmes, 70 % avaient encadré des résidents allaitant, 40 % avaient abordé la question des aménagements pour l'allaitement, et tous étaient favorables à l'instauration d'une politique. Parmi les 24 résidents interrogés : 45 % ont atteint leurs objectifs d'allaitement, 74 % ont cessé d'allaiter prématurément en raison d'obstacles professionnels, et 88 % ont signalé un faible soutien sur leur lieu de travail. Presque tous les résidents (96 %) étaient favorables à l'élaboration d'une politique.
Conclusion : Il existe une opportunité et un besoin pour une politique plus complète en matière d'allaitement et de lactation pour les résidents en chirurgie au Canada. Notre politique met en lumière les domaines clés où les résidents pourraient être mieux soutenus pour atteindre leurs objectifs d'allaitement.
Parties annexes
Bibliography
- Public Health Agency of Canada. Chapter 6: breastfeeding. Ottawa: Public Health Agency of Canada; 2019. Available from: https://www.canada.ca/en/public-health/services/publications/healthy-living/maternity-newborn-care-guidelines-chapter-6.html
- World Health Organization. Guideline: counselling of women to improve breastfeeding practices. 2018.
- Chantry CJ, Howard CR, Auinger P. Full breastfeeding duration and associated decrease in respiratory tract infection in US Children. Pediatrics. 2006;117(2):425-432. https://doi.org/10.1542/peds.2004-2283
- Sullivan S, Schanler RJ, Kim JH, et al. An exclusively human milk-based diet is associated with a lower rate of necrotizing enterocolitis than a diet of human milk and bovine milk-based products. J Pediatr. 2010;156(4):562-567.e1. https://doi.org/10.1016/j.jpeds.2009.10.040
- Chen A, Rogan WJ. Breastfeeding and the risk of postneonatal death in the United States. Pediatrics. 2004;113(5):e435-e439. https://doi.org/10.1542/peds.113.5.e435
- Greer FR, Sicherer SH, Burks AW, et al. The effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, hydrolyzed formulas, and timing of introduction of allergenic complementary foods. Pediatrics. 2019;143(4). https://doi.org/10.1542/peds.2019-0281
- Owen CG, Martin RM, Whincup PH, Smith GD, Cook DG. Effect of infant feeding on the risk of obesity across the life course: a quantitative review of published evidence. Pediatrics. 2005;115(5):1367-1377. https://doi.org/10.1542/peds.2004-1176
- Rudant J, Orsi L, Menegaux F, et al. Childhood acute leukemia, early common infections, and allergy: the ESCALE study. Am J Epidemiol. 2010;172(9):1015-1027. https://doi.org/10.1093/aje/kwq233
- Rosenbauer J, Herzig P, Giani G. Early infant feeding and risk of type 1 diabetes mellitus—a nationwide population-based case–control study in pre-school children. Diabetes Metab Res Rev. 2008;24(3):211-222. https://doi.org/10.1002/dmrr.791
- Kramer MS, Fombonne E, Igumnov S, et al. Effects of prolonged and exclusive breastfeeding on child behavior and maternal adjustment: evidence from a large, randomized trial. Pediatrics. 2008;121(3):e435-e440. https://doi.org/10.1542/peds.2007-1248
- Vohr BR, Poindexter BB, Dusick AM, et al. Beneficial effects of breast milk in the neonatal intensive care unit on the developmental outcome of extremely low birth weight infants at 18 months of age. Pediatrics. 2006;118(1):e115-e123. https://doi.org/10.1542/peds.2005-2382
- Furman L, Taylor G, Minich N, Hack M. The effect of maternal milk on neonatal morbidity of very low-birth-weight infants. Arch Pediatr Adolesc Med. 2003;157(1):66. https://doi.org/10.1001/archpedi.157.1.66
- Krause KM, Lovelady CA, Peterson BL, Chowdhury N, Østbye T. Effect of breast-feeding on weight retention at 3 and 6 months postpartum: data from the North Carolina WIC Programme. Public Health Nutr. 2010;13(12):2019-2026. https://doi.org/10.1017/S1368980010001503
- Henderson JJ, Evans SF, Straton JAY, Priest SR, Hagan R. Impact of postnatal depression on breastfeeding duration. Birth. 2003;30(3):175-180. https://doi.org/10.1046/j.1523-536X.2003.00242.x
- Schwarz EB, Brown JS, Creasman JM, et al. Lactation and maternal risk of Type 2 Diabetes: a population-based study. Am J Med. 2010;123(9):863.e1-863.e6. https://doi.org/10.1016/j.amjmed.2010.03.016
- Schwarz EB, Ray RM, Stuebe AM, et al. Duration of lactation and risk factors for maternal cardiovascular disease. Obstetr Gyn. 2009;113(5):974-982. https://doi.org/10.1097/01.AOG.0000346884.67796.ca
- Collaborative Group on Hormonal Factors in Breast Cancer. Breast cancer and breastfeeding: collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, including 50 302 women with breast cancer and 96 973 women without the disease. The Lancet. 2002;360(9328):187-195. https://doi.org/10.1016/S0140-6736(02)09454-0
- Lipworth L. History of breast-feeding in relation to breast cancer risk: a review of the epidemiologic literature. J Natl Cancer Inst. 2000;92(4):302-312. https://doi.org/10.1093/jnci/92.4.302
- Cantu RM, Gowen MS, Tang X, Mitchell K. Barriers to breastfeeding in female physicians. Breastfeeding Med. 2018;13(5):341-345. https://doi.org/10.1089/bfm.2018.0022
- Dixit A, Feldman-Winter L, Szucs KA. “Frustrated,” “depressed,” and “devastated” pediatric trainees. J Human Lact. 2015;31(2):240-248. https://doi.org/10.1177/0890334414568119
- Ames EG, Burrows HL. Differing experiences with breastfeeding in residency between mothers and coresidents. Breastfeeding Medicine. 2019;14(8):575-579. https://doi.org/10.1089/bfm.2019.0001
- Canadian Medical Association. Number and percent distribution of physicians by specialty and gender, Canada 2019 Specialty.; 2019.
- Balk SJ, Yellin TG. Breast-feeding during pediatric residency: is ‘breast-fed is best fed’ only for others? Pediatrics. 1982;70(4):654-654. https://doi.org/10.1542/peds.70.4.654
- Al-Imari L, Hum S, Krueger P, Dunn S. Breastfeeding during family medicine residency. Fam Med. 2019;51(7):587-592. https://doi.org/10.22454/FamMed.2019.759632
- Rangel EL, Smink DS, Castillo-Angeles M, et al. Pregnancy and motherhood during surgical training. JAMA Surg. 2018;153(7):644-652. https://doi.org/10.1001/jamasurg.2018.0153
- Mills G, Ruzycki SM, Sabourin J, Dance E. Experiences of breastfeeding among women residents in Alberta: a cross-sectional survey. Postgrad Med. 2021;133(1):42-47. https://doi.org/10.1080/00325481.2020.1814581
- Cole S, Arnold M, Sanderson A, Cupp C. Pregnancy during otolaryngology residency: experience and recommendations. Am Surg. 2009;75(5):411-415. https://doi.org/10.1177/000313480907500512
- Finch SJ. Pregnancy during residency. Acad Med. 2003;78(4):418-428. https://doi.org/10.1097/00001888-200304000-00021
- Ziolkowski N, Rogowsky L, Innis J, Grant Buechner A, Springall E, Dengler J. Creation of a nationwide breastfeeding policy for surgical residents: a scoping review protocol. BMJ Open. 2022 Jun 13;12(6):e047466. https://doi.org/10.1136/bmjopen-2020-047466.
- Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Method. 2005; 8(1):19-31. https://doi.org/10.1080/1364557032000119616
- Levac D, Colquhoun H, O'Brien KK Scoping studies: advancing the methodology. Implementation Sci. 2010; 5(69). https://doi.org/10.1186/1748-5908-5-69
- Juengst SB, Royston A, Huang I, Wright B. Family Leave and Return-to-Work Experiences of Physician Mothers. JAMA Netw Open. 2019;2(10):e1913054. https://doi.org/10.1001/jamanetworkopen.2019.13054
- QS World university rankings top medical schools. QS Quacquarelli Symonds. 2022. Available from: https://www.topuniversities.com/university-rankings/university-subject-rankings/2022/medicine. [Accessed Oct 10, 2022].
- Livingston-Rosanoff D, Shubeck SP, Kanters AE, Dossett LA, Minter RM, Wilke LG. Got Milk? Design and implementation of a lactation support program for surgeons. Ann Surg. 2019;270(1):31-32. https://doi.org/10.1097/SLA.0000000000003269
- Johnson HM, Walsh DS. Crafting an evidence-based, accreditation council of graduate medical education-compliant lactation policy for residents and fellows. Breastfeeding Med. 2020;15(1):49-55. https://doi.org/10.1089/bfm.2019.0201
- Trigo S, Gonzalez K, Valiquette N, Verma S. Creating a lactation-friendly learning environment for medical students and residents: a Northern Canadian perspective. Breastfeeding Med. 2021;16(7):511-515. https://doi.org/10.1089/bfm.2020.0331
- Ramsey KW, Beckwith N, Heathcock L, Myers T, Balaraman V. Advocating for a culture of support for lactating medical residents in Hawai'i. Hawaii J Health Soc Welf. 2021;80(12):304-306. PMCID: PMC8646861.
- Melnitchouk N, Scully RE, Davids JS. Barriers to breastfeeding for US physicians who are mothers. JAMA Intern Med. 2018;178(8):1130. https://doi.org/10.1001/jamainternmed.2018.0320
- Sattari M, Serwint JR, Neal D, Chen S, Levine DM. Work-place predictors of duration of breastfeeding among female physicians. J Pediatr. 2013;163(6):1612-1617. https://doi.org/10.1016/j.jpeds.2013.07.026
- Champaloux EP, Acosta AS, Gray ST, Meyer TK, Bergmark RW. Otolaryngology residents’ experiences of pregnancy and return to work: a multisite qualitative study. Laryngoscope Investig Otolaryngol. 2022;7(5):1322-1328. https://doi.org/10.1002/lio2.878
- Castillo-Angeles M, Smink DS, Rangel EL. Perspectives of US general surgery program directors on cultural and fiscal barriers to maternity leave and postpartum support during surgical training. JAMA Surg. 2021;156(7):647-653. https://doi.org/10.1001/jamasurg.2021.1807
- McMillin A, Behravesh B, Byrne P, Unruh GK. A GME wearable breast pump program: an innovative method to meet ACGME requirements and federal law. J Grad Med Educ. 2021 Jun;13(3):422-423. https://doi.org/10.4300/JGME-D-20-01275.1
- American College of Surgeons. Revised statement on the importance of workplace accommodations for pregnancy, parental leave, and lactation support for practicing surgeons. Available from: https://bulletin.facs.org/2021/08/revised-statement-on-the-importance-of-workplace-accommodations-for-pregnancy-parental-leave-and-lactation-support-for-practicing-surgeons/. [Accessed Feb 22, 2023].
- Accreditation Council for Graduate Medical Education. ACGME common program requirements (Residency); 2022. Available from: https://www.acgme.org/globalassets/PFAssets/ProgramRequirements/CPRResidency_2022_TCCv2.pdf. [Accessed Feb 22, 2023].
- American Academy of Family Physicians. Breastfeeding and lactation for medical trainees. Available from: https://www.aafp.org/about/policies/all/breastfeeding-lactation-medical-trainees.html. [Accessed Feb 22, 2023].
- Creo AL, Anderson HN, Homme JH. Productive pumping: a pilot study to help postpartum residents increase clinical time. J Grad Med Educ. 2018;10(2):223-225. https://doi.org/10.4300/JGME-D-17-00501.1
- The Canadian Resident Matching Service. R-1 match reports. 2022. Available from: https://www.carms.ca/data-reports/r1-data-reports/ [Accessed Mar 2, 2023].