Lactation Wellness Policy

Department Support: The University of California, San Francisco Department of Surgery intends to protect the health and wellbeing of faculty and learners, promote diversity, equity, and inclusion, and support the current and training the next generation of surgeons. With input from various stakeholders and in alignment with guidance from the Office of Graduate Medical Education (GME) and University of California Human Resources Policy for Accommodations for Nursing Mothers, we have developed the following guidelines for lactation-oriented wellness among faculty and surgical trainees. These guidelines are intended to serve not only as practical advice to faculty, trainees, and staff, but also as a statement of support of each person’s family choices.

Background: National guidelines recommend that infants receive human milk exclusively for the first six months of life, with continued human milk for at least the first year of life.This recommendation is based on health benefits to both infants and lactating parents.

Returning to work is associated with shortened duration of lactation. Reduced milk supply can result both from the stress of returning to work and use of a pump for milk expression. When direct feeding is not possible, milk expression (pumping) at regular intervals is necessary to maintain milk supply and prevent discomfort or infection (mastitis). Although the necessary interval varies from person to person, most people need to express milk every 2-4 hours, and in general, each person needs 20-30 minutes for milk expression and storage. Despite these physiologic needs, workplace schedules often do not provide proactive support to easily enable breaks for pumping.

Surgeons face challenges with lactation, including insufficient or infrequent time to express milk, inability to nurse, and the emotional toll of long hours away from one’s child.

Best Practices: The ACGME, UCSF GME, and the University of California all have requirements to support lactating trainees and employees. Lactation accommodations should be provided for at least the first year of the child’s life.Please visit UCSF Lactation Accommodation Program website for more details about available support for employees, trainees, and students.

The GME suggests the following principles in support of best practices, which apply to both trainees and faculty:

1. Normalization – milk expression is a physiologic need and should be anticipated as a routine aspect of returning to work after childbearing. Faculty and trainees should be supported to meet this need without concern for retaliation or negative impact on clinical training and educational experience.
2. Transparency - Resources to support lactation should be easily accessible. The department should provide information about options to have protected time for pumping during specific rotations and at different sites.
3. Proactiveness – The department should have a process in place for reaching out to faculty and trainees prior to anticipated childbearing leave and prior to return to work, in order to share resources and options for lactation support.
4. Customization - As with any accommodation, specific needs and resources for lactation support should be discussed and adapted for each individual.

• Responsibilities of the lactating resident
  • The resident will provide clear communication with program director, attending surgeons, and colleagues regarding specific needs for lactation (including resources required, private space, time interval and duration). If barriers to the necessary resources are encountered, the resident will work with faculty to troubleshoot and make arrangements to accommodate these needs (e.g. convert a workroom close to the operating rooms to a designated lactation space).
  • The resident will provide notice of their need to express milk to the program director before returning from childbearing leave. The designated program point person will then contact rotation directors and faculty to make them aware of the need for protected time for pumping. Trainees can also contact the on-site faculty directly if they prefer.
  • The resident should consider, when appropriate (and at the trainees’ discretion), also providing notice to their co-resident colleagues.
  • In general, the lactating resident should aim to (1) disrupt patient care as little as possible within reason, (2) continue to focus on high-yield learning opportunities, and (3) build and maintain honest, open communication with their team.  
  • Certain clinical situations may require specific guidelines:
    • Clinic
      • The lactating resident will be allowed to leave clinic for at least 30-minute intervals every 2-4 hours required for milk expression.
      • The lactating resident will not leave during a patient encounter.                                             
    • Operating room 
      • The lactating resident will notify the attending ahead of time of the interval and duration needed to express milk. Each person will have unique lactation timeline needs, but an average timeline is 30 minutes to pump every 2-4 hours. Faculty and the lactating resident will work together to develop a plan for coverage in the OR if needed.                                          
    • Research
      • The lactating resident will be allowed at least 30-minute intervals every 2-4 hours required for milk expression. There should be an option to participate in research remotely when possible.

• Responsibilities of faculty
• Maintain professional and open communication with trainees who are known to have family obligations, particularly those who have given birth within the past 12 months.
• Identify ahead of time anticipated coverage needs for times when the lactating resident needs to leave the OR to express milk. Each attending will have a different preference for how cases are covered, but this should be clearly articulated to the lactating resident.
• Provide support and arrangements to accommodate each lactating trainee’s specific needs to optimize personal, learning, and service-related goals and responsibilities.

B.  Best Practices to Support Lactating Faculty

The department acknowledges the challenges for lactating faculty members after return from childbearing leave given the demands of clinical work. The department is committed to being proactive in providing information about lactating spaces and creating a flexible environment that accommodates the schedule of each individual. The faculty member will discuss with the section or division chief the need for lactation support before returning from child-bearing leave.

• Lactation Hold Program for ambulatory care setting: Faculty returning from child-bearing leave are given the option of adding one 30-minute “Lactation Hold” appointment to their clinic schedule per half-day session. This lactation hold can be placed anywhere in a 4-hour session and will result in wRVU credits being given to the clinician’s home department on a quarterly basis for disbursement of funds to the clinician. Each Lactation hold is reimbursed as a set amount of wRVU --- equivalent to a 30-minute patient visit (currently 1.92 wRVU).
• The department will work locally with each clinical site and the Campus Lactation Services to identify lactation spaces near the Operating Suite, equipped with desks, computers, phones, and refrigerators for safe milk storage.
• The department will work locally with each clinical site and the Campus Lactation Services to provide easy access to lactation supplies (including variety of pumps and pumping equipment).
• More information can be found at Lactation Credits for UCSF Health Ambulatory Clinicians