How To (and not) Breast Pump at Work

A friend of mine (anesthesiologist) is expecting her first baby any day now. She had a lot of questions about breast pumps, ie how difficult was it to pump at work? How did you deal with call? What were your colleagues' attitudes towards pumping? What breast pumps would you recommend? How much time does it take to pump (on average)? How long did you breastfeed for, and was your decision to stop influenced by work issues?
I did read Fizzy's post a while ago (formula vs breast milk) but my friend and I want to know the details. If you don't feel this would be too repetitive, it would be great to hear what the other mothers in medicine think.
Liana

My daughter, Sicily, was a dream baby as far as the pumping goes. I'm paying for it now, in elementary school, but that is the topic of another blog. Pumping was tough to learn, but once my friend Mel showed me the ropes, it was smooth sailing. I had a top of the line Medela - I'm sure there's a newer model out now. It was worth it to me to shell out the bucks for efficiency. All of the books recommend that you pump as often as you would nurse, but when you have a hungry, demanding baby this seems unreasonable. I usually tried to pump twice a day at work. I was on clinical pathology rotations my second year of residency - had adequate time to manage my goals. I studied during the process.

I tried to pump in the pumping station at the hospital near OB, but it was so far away and all of the dried milk spots on the chairs, walls, and floors in the cubicles behind sheeted doors freaked me out. So I used Mel as a mentor again and pumped in an empty apheresis room - nice and clean. And I'm nice and clean so it worked out for the apheresis attending. I usually pumped at 10:00 and 2:00 - it took about thirty minutes start to finish, including rinsing out the parts and storing the milk. Toward the end I was able to back off to once a day when my production started waning. There was one unfortunate incident of a male nurse walking in on me while I was pumping - it was embarrassing at the time but funny in retrospect - he couldn't look me in the eye for weeks. I think he was more embarrassed than I was.

I was a cow as far as production goes - I remember once falling to pieces when the power went out on a weekend when I was alone at home. I called the poor Entergy company assistant in tears.
"When is the power coming back on? I have all of my milk in the freezer! If it thaws, I will have to throw it away. Are you sure they are fixing it? Can you please tell me again the exact time you expect it to come back on?"

When you work that hard, a tiny bag of frozen milk is like liquid gold.

I pumped/nursed for eleven months with Sicily. It was just time to quit - we both seemed to know it. It was a very smooth transition to frozen milk, and she was on formula by a year.

When I had my son two years and four months later, I thought I was living my dream. Perfect marriage, doctor husband, girl and boy, and well on my way to (in my opinion, and many others, some will beg to differ - there are a lot of great jobs in this state) the best job in the state. I was going to work at the hospital my dad and husband worked at. Plans don't always work out the way you want them to, but this isn't always a bad thing.

At the time, things were going according to my plan. But with my son John, things degenerated. He didn't sleep all night at three months like my daughter - he wanted to nurse three times a night. Hard to blame him - he didn't get much of me during the day - but it was killing me. I was also on some tougher rotations, so I reduced pumping to once a day. I would nurse in the wee hours of the morning, pump again after getting ready before I went to work, and suck it up until around noon, when my breasts were like lead balloons. Well, not really lead - they were a little more lumpy. Think a million tiny shrubs under your skin, full to bursting point. I had to get a third storage bottle - I was going way over 12 ounces. I didn't have time to go down to the apheresis unit on the first floor. I just ate a quick stash of processed food for lunch, and made fast friends with the residency coordinator/mom, who let me pump in her office. I could squeeze it in (or out!) in twenty minutes, now. I was a little more rushed overall, at that time in my life.

I sat on the residency coordinator's floor with my face to the wall. Sometimes she left. Sometimes she stayed, and we chatted about kids, life, and family. I really enjoyed that - it was one of the highlights of my day. Female bonding.

This style of pumping was OK for John, but not for me. I had a lot more problems with dehydration and blocked ducts. I've got a pretty high pain tolerance, but blocked ducts have to be one of the most painful experiences on the planet. Worse than childbirth (well, I did have epidurals, so that is not a fair comparison). When he was around seven or eight months, in early winter, I let him cry it out at night, and stopped nursing. This was a much more painful emotional experience because A) We weren't ready B) I was exhausted and had to start studying for my Anatomic Pathology/Clinical Pathology boards in June and C) I was beyond sad and depressed and strung out and D) I knew this would probably be my last time to nurse. It was an amazing experience overall, and I couldn't see myself ever doing it again. I was going to miss it. Luckily, I have nursing dreams to remember the rush of relaxing hormones that accompanied contraction and let-down. I am not talking about pumping here, I'm talking about the real thing.

I wish I could speak to the call, but we pathologists get a break, on the call. So hopefully someone will comment on that in the comment thread. Colleagues attitudes - I am sure I occasionally annoyed, but this was usually temporary, situational, and not always my fault. It is tough to control other people's moods, and sometimes they will project their frustrations onto anything. I did have to get coverage some days, especially with John, when I was responsible for junior residents or covering frozens. People ask to be covered for a lot of reasons, and this was one of the few I asked, so I tried not feel too guilty when others worked for me and made sure to do extra favors when I was around. I like to think that overall I was admired tremendously by residents and attendings. I'll bet if I took a survey the results would back up my hunches.

I am proud of all of my efforts and work, even though it got a little crazy, single-minded, and self-sacrificing at the end. I beat myself up way too much for giving Sicily that extra few months - I felt like John needed it more, since he was six weeks premature. But he is a happy, healthy, well-adjusted four and a half year old, so I think I did all right by them both, in hindsight.

Tell your friend good luck, Liana! Thanks for the question.