138 - Perceptions of Lactation-Related Discrimination Experienced by Physician Mother Trainees

Poster Number: 138
Publication Number: 138.217

Caitlin Billingham, Stanford University School of Medicine, Redwood City, CA, United States; Jessica M. Gold, Stanford University School of Medicine, Palo Alto, CA, United States; Caroline Rassbach, Stanford University School of Medicine, Palo Alto, CA, United States

Background: Due to a variety of unique barriers in the workplace, physician mothers are less likely to meet their desired breastfeeding goals, despite policies that may exist to protect them. Aggregate survey data suggests that instances of maternal bias and discrimination in the workplace are high, often directly related to breastfeeding practices. These barriers are even more pronounced for female physician trainees than their faculty counterparts. To date, no prior studies have explored the collective lived experience of breastfeeding trainees across disciplines.

Objective: 1) Explore the experience of female trainees as they navigate lactation at work while fulfilling clinical duties, 2) Understand workplace culture as it relates to lactation, 3) Describe perceptions of lactation-related bias or discrimination witnessed or experienced, 4) Summarize barriers and strategies for improving the institutional environment surrounding lactation.

Design/Methods: This is an IRB-approved, exploratory study using qualitative methods with a phenomenological framework. We conducted semi-structured focus groups of physician mother trainees (residents and fellows) across disciplines within the Stanford housestaff community between January—May 2020. Sessions were audio recorded and transcribed verbatim. Two authors independently coded transcripts, with validation by a third author for consensus of thematic analysis and member checking for accuracy. Results were analyzed through the lens of Cruess et al.’s conceptual framework of professional identity formation in medicine.

Results: Data analysis from 4 focus groups (n = 16), representing 12 different medical and surgical subspecialties, revealed 5 overarching themes (see Table 3). Trainees reported significant breastfeeding barriers in the healthcare system and learning environment, including but not limited to, emotional toll, discrimination, and mistreatment. We summarized participants’ asks and suggestions in a comprehensive guide for institution-level change.Conclusion(s): Our data demonstrates a pressing need for comprehensive institutional policy, education, and workplace culture change to better support breastfeeding trainees. Participants advocated for improved paid parental leave benefits, financial coverage for wearable pumps, and more robust and protected avenues for reporting breastfeeding discrimination, among other priorities. This study has direct implications for the assurance of a safe and nondiscriminatory work environment for medical trainees at our own institution and beyond.
Table 3. Focus Group Themes Representing the Experiences of Breastfeeding Trainees