“Pumped” in JAMA

I was at our block education the other day when one of my male co residents asked me, “Did you read the JAMA reflection piece from Sept 11?” (answer to this is always no, my JAMA sits on my kitchen table where it’s main purpose in life is to be an excellent spider squisher). When I said I hadn’t, he took his issue out of his backpack and gave it to me.

If you haven’t seen it, the article is called Pumped by Dr. Charlotte Grinberg. (Article here). It is a fantastic reflection on pumping during intern year and like most reflections on pumping I identified with it so much. I almost cried when *spoiler alert* her freezer broke and she lost her stash. And cheered at the final couple of paragraphs.

I am so happy to see this in JAMA. My coresident told me - “I read it and thought of you guys”. I’d lately been fielding comments like “I wish I got a twenty minute break in my clinic schedule!” so it was great to hear something more affirming. I suppose my male coresidents are less likely to be reading blog posts on mothersinmedicine.com so I’m hopeful this will bring more discussion and more advocacy to pumping residents among the non pumpers among us.

Re: my own pumping journey - baby is 11 months and we have almost made it to a full year of exclusive breast milk due to the combination of ridiculous pumping sessions, learning to advocate for myself, a lot a lot of luck, and a pretty supportive work environment. Cant wait to celebrate his one year journey by temporarily retiring the Spectra. 

Adventures in Pumping II: The rotating resident

Here is my past few months in pumping chronicled by rotation. As the weeks went by, I turned from a shy awkward pumper to a frank “I’ll do it wherever just get me a plug in” resident.

Ortho: show up to clinic struggling with clinic bag in one hand and pump in the other. Young ortho PA that I am scheduled with has kids, gets it, and finds me a private office for the day.

Cardiology: lots of older male physicians, and scheduled with a new one every half day. Rather than explain the pumping every single half day, I pump on the way to and from work and simply say I need to leave half an hour early to make my q4h schedule. I don’t say why, they shrug and say sure. I tell the younger female cardiologists I need to pump and they “remember those days” and are full of support.

Hospice: in a car with my wheelie backpack going to multiple hospice sites. At one point, I am stuck far from my pump as I misjudged how long the trip would take me and as my mentor for the day is sharing a deeply emotional story as we are ending or day together, all I can think is “gottapumpgottapunpgottapump”. Also had a mentor that went to NP school in the pre-double electric breast pump days and not-so-fondly remembers hand expressing during breaks. I’m so glad we’ve come far from that.

Night float: Sitting in my call room calling specialists with the little “whirr whirr” in the background. Eye the pagers carefully, just daring them to go off with a Code Blue while I am plugged in.

In between, check Facebook. That Willow pump that keeps haunting my news feed with ads looks wayyyy too good to be true. But cheering on the days to an better breast pump.

Psych: checking into an attending’s office for a half day. He has a no show, so I casually mention I need to pump sometime in the next two hours. Ten minute tour through the offices ensues, ending with me pumping in his private office and him waiting outside in his own lobby.

Clinic: having much more in depth conversations with my patients about pumping, supplementing, etc. Run downstairs every 3-4 hours past all the patients in the lobby past  to the pump room, stopping to briefly complain to the care coordinator about how pumping sucks literally and figuratively as we both have babies within a few weeks of each other. She made it a year with her first so we are cheering each other on.

Conference: presenting a poster at a conference at a large office building. Find the pump room of dreams including sink, long counter, multiuser pump, fridge, large comfy chair. Immediately send an email to my office manager outlining this in case we ever have extra money lying around when we design our next clinic. The pump room is in use when I need it in the afternoon, so I am directed to a Breastfeeding Pod (called a Mamava) that looks like one of those party photo booths. Crawled inside, feeling slightly seasick but very private and secluded in my little cocoon.

OB: I pick up an OB shift for a resident out sick. I sit in the pump room in peace wishing I could figure out how my Spectra parts could attach to the multi user hospital Medea  pump. I get to work with the nurses who helped deliver Baby, show them pictures, and they let me eat from their potluck spread.

I mainly wanted to write this all down so I can remember both the ridiculousness and support when we’re finally ready to shelve the pump. Hopefully someday I can say “I remember when I had to haul my pump around with lots of parts from place to place in a huuuuuuge bag! You have it so much easier now!” Until then, pump and I will continue to hit the road.

Kicks

Adventures in Pumping

Life is going pretty great for Team Kicks. Baby is almost 4 months old and is a complete joy. He has a sweet easygoing temperament and *usually* sleeps through the night. We are so spoiled and it is so easy to leave work behind and come home and cook dinner while we sing to each other - me from the oven and counter and Baby from his bouncy seat on the kitchen floor - then playing and rolling (!) until bedtime. Love.

However I grossly underestimated how not-fun it would be to be a resident and pumping. The number one thing I underestimated was how hard it is to keep and transport clean parts. There are CDC guidelines for this stuff - wash every time, let air dry, yada yada yada. Not happening. In the fridge the parts go. I have one friend who has an extra set of parts at work for each pumping session. Love the idea but my pump (Spectra) is huge. I was traveling with two bags for awhile (pump bag + work bag, not to mention a coffee thermos in one hand and a water bottle in the other) but I was clearly such a hot mess trying to keep all my things afloat my mom finally bought me a little wheelie suitcase that at least fits all my pump parts. So I wheel around the clinic and the hospital and started leaving my laptop at home which at least makes me appear a bit more together.

I told myself early on that breastfeeding was NOT going to be something I was going to lose my mind over. I was not going to schedule a middle-of-the night pump - if Baby is sleeping, I am sleeping. If I had to give up breastfeeding for any reason, fine. I was a formula fed kid and I turned out a-ok. As I tell my moms in clinic,  the best thing for baby is to be a fed baby with a minimally stressed mom. However, as I found myself pumping in my car on the way to work in a skinny little nursing sheath in subzero winter temperatures and a car that was slow to warm up, I questioned whether I was actually sticking to this sanity thing.

I would like to dedicate this post to my 3 pump-spirations - I have three wonderful co-pumping co-residents in my life. One has a similar go-with-the-flow (hehe pump puns) attitude towards breastfeeding as myself and was the first to recommend car pumping. One has a baby almost 6 months older and was answering my very basic pump questions via text months and months earlier. And one is so dedicated she has a middle of the night pump scheduled to keep her supply up and she is still a bomb resident every single day. My residency is so pump/breastfeeding friendly I've never seen a new mom resident without a breast pump along. So we can do this. Plus anything after 6 months I consider a bonus.

I still have so much more to share about pumping. Awkward conversations with older male specialists. An episode with a preceptor where I was about to run to my pump an hour later than planned when my preceptor started sharing this emotional story and all I could think about was...time to pump....time to pump.... So sanity = questionable. I do address pumping a lot more with my postpartum moms in clinic now - especially with my non-English speaking patients who I discovered I had been prescribing double electric breast pumps for but never addressing how/when/why to use it.

If I had any tips for pumping residents/students/physicians so far I would say 1) hands free pumping bra 2) pumping in the car is a game changer and 3) seriously go buy a wheelie suitcase with all the pockets if you don't have a nice pump bag. Anyone else have any tips? Still have a few months to go. Would also love to hear some ridiculous making-the-pump-work-at-work stories if you've got 'em.

MiM Mail: Pumping while on call

Dear MiM,

I am nearing the end of my glorious maternity leave. As my first day back in the OR draws near, I would love any and all advice on how to make breastfeeding work while having to do 24-28 hour calls. Obviously I will be pumping as much as possible while on call, but have been warned by all (including lactation consultant and pediatrician) of the likelihood of dwindling milk supply given the long times away from my baby.

Thanks in advance!

MiM Mail: Getting the milk home

Hi MiM,

Avid follower of five years (you got me through training...almost! Last year of fellowship. Thank you!).

Very concrete question:
I have to leave my nursing nine month old for two days and two nights for a conference (he is currently seven months old and I am anxious about this process). I will have to bring my pump, but I need some suggestions about getting the milk home. Carry on airplane with ice (does this entail a bigger ordeal since I won't have an infant with me)? Mail with dry ice? What has worked for fellow MiMs? I really appreciate your advice. I'm worried about the separation and channelling my anxiety into figuring out this milk transportation situation!

Appreciatively,
Dedicated MiM follower

Pump hero

I needed to meet with a team to grade their students and had set up a time to meet them in their team room. This is one of the best team rooms we have in the hospital. It's spacious, with a wall of computer stations on either side, and windows lining the opposite wall from the door, filling the room with natural light. When I'm bringing the third-year students around to their team rooms after orientation, I always deliver this team's students last since it's kind of like closing the curtain between first class and coach.

I walked into the room and saw a medicine intern with her back to me, working at her computer. At the other wall, the senior resident was reading some papers before him. They greeted me as I sat down with my folders and took out my forms for grading.

"I hope you don't mind, but I'll be pumping while we do this." In the sudden quiet, I heard the telltale rhythmic sounds that I knew so well. She was pumping. Right there. In the team room. I didn't notice earlier, but she apparently had a hands-free set-up going, and was typing away, doing her notes. I glanced back at the senior resident, nonplussed. This was routine business.

I was filled with...joy. Admiration. So impressed.

"I think it is so awesome that you pump in the team room!" (Could I have?)

"I've lost all modesty after 9 months," she said with a smile.

We graded. She finished pumping, cleaned up, stored the milk, and I could not stop smiling.

The Sucking Machine

I recently gave up nursing. That part was hard. Giving up pumping was easy.

I'm going to go out on a limb and say that nobody likes breast pumping. When you're nursing, there's that wonderful bonding... but when you pump, it's just you and The Sucking Machine. It requires a tremendous amount of dedication for any woman, but I really think that it's harder for a physician-mama than most. And even harder if you're a resident-mama.

The problem with being a pumping resident is that there's no natural break scheduled into the day where you can retire into the coat room with your pump. On clinic rotations, I usually ended up working right through lunch, so no free time there. On ward rotations, there was usually some downtime, but I always lived in fear of hell breaking loose mid-pump. And ladies, is there anything more embarrassing than answering a page with your pump going in the background?

Some women I know in non-medical professions told me that I "have a right to be given time to pump!!!" (Note the use of multiple exclamation points.) Unfortunately, it doesn't really work that way in the hospital, especially if you're the lone resident on the ward.

Nurse: "Mr. Smith is having 10 out of 10 crushing chest pain and shortness of breath!"

Me: "Sorry, I'm on a pumping break. Try me again in 20 minutes."

Since I had no office, most of my pumping for the first three months was done in a "family room" on the inpatient ward, which was usually unoccupied. Unfortunately, the room had a bed and several patients' families were convinced I was going in there to nap. I wish.

After that, I moved to a different hospital and I had two choices for pumping: Empty Patient's Room or Glorious Pumping Lounge. Glorious Pumping Lounge had everything but a running waterfall in the background, but it was a five mile trek in hiking books from my ward, so I usually opted for Empty Patient's Room. And routinely got walked in on by the janitorial staff.

I managed to pump until Melly was seven months old, exceeding my goal of 6 months, and I nursed quite a bit longer. I think I did good. Next time I'm going to go for the whole year.

Multi-tasking

Today was one of those insanely busy days, the kind that I had never come close to encountering prior to having my first child. On top of my regular clinical duties, I had additional responsibilities that had been "saved" for me since I couldn't do them while (inconveniently) out on maternity leave. The end result was that I ran around like a headless chicken trying to round with my housestaff, see consults, see clinic patients, fit in two pumping sessions, and deal with some seriously crazy patient scenarios, straight out of Grey's Anatomy.

Today, multi-tasking was the only way I could survive. I seriously had almost no time to sit still, I barely ate lunch (two hours after I initially heated it in the microwave), and always, always took the stairs.

My most peaceful moments were, coincidentally, while pumping. At least then I had no choice but sit in my office and internet surf or read my email (probably against OSHA regulations to walk around the corridors while pumping).

Of course, during my second pumping session, I actually paged the resident I was working with on consults to discuss our patients, you know, seriously multi-tasking. I made no excuses for the background whirring noise. "I'm pumping," I announced unceremoniously at the beginning. There was no time to be modest.

(I knew she was a mother; I certainly wouldn't have said this if she were a man.)

She chuckled. "I've so been there."

Which is why I love working with housestaff who are mothers themselves. There's an unspoken understanding.

They get it.