Catherine Wagner’s daughter Lucy started walking recently, taking off with enthusiasm and hesitation once she realizes she is walking unaided. It’s scary to start something new on your own.
Wagner, cardiothoracic surgery resident at Michigan Medicine, could relate in some ways. Trying to figure out how to breastfeed and pump while in residency was unfamiliar and sometimes scary territory, but a support network meant she wasn’t doing it alone.
“Everyone wanted to support me on this journey and that’s what helped me achieve a pumping year,” Wagner said.
An integrated community to rely on
Surgical residents who had come before Wagner laid the foundation for policies regarding the reception of lactation trainees. Sarah Shubeck, MD, MS, and Arielle Kanters, MDformer general surgery residents at Michigan Medicine, have collaborated with Megan Pesch, MDclinical lecturer in the Department of Pediatrics, develop policies around lactation.
Policies have established practical guidelines for providing dedicated time and space for pumping. They also helped set the cultural tone, so Wagner felt comfortable approaching other residents about their experiences in preparation for her own trip. People she had never met also took the initiative to reach out after the birth of her daughter to register and offer advice and support.
“The community of surgical moms is incredible. When I was preparing to return to work, I felt comfortable asking how they fit into pumping as clinical residents. All responded differently, but all of their advice helped me,” Wagner said.
Support from other residents who had been on the pumping route during the training went beyond advice on equipment, with one even offering to lend a portable pump to Wagner to try out. .
Male co-residents and attending surgeons couldn’t offer the same kind of advice and support as her female residents, but Wagner says they were understanding and accommodating.
“Many of my male co-residents had had babies and seen their wives go through pumping, so many of them knew what the requirements were. I relied on my co-residents to support me in the day-to-day work,” Wagner said.
A matter of timing and balance
The integrated cardiothoracic residency program includes six years of clinical training and two years of community research. The years of research may have made it easier to have a child for several reasons, including not having to figure out how to pump in surgical cases. However, Wagner was also aware that the wait could present other challenges.
“A lot of surgical trainees have difficulty getting pregnant(link is external). I knew this and did not want to delay starting a family for fear of the impact it would have on my clinical training. I thought there was no good time to start a family, so let’s see what happens,” Wagner said.
Wagner worked until she gave birth to Lucy at 39 weeks and took 12 weeks off after the birth. She credited the accommodations put in place by the Department of Cardiac Surgery and the Department of Surgery to protect pregnant interns and facilitate healthy pregnancies with her ability to work so late in her pregnancy. Key accommodations allow pregnant trainees to wash every 3-4 hours for breaks, exempt them from clinical duties for all antenatal care appointments, and exempt them from night shifts and shifts longer than 12 hours during the third trimester. Wagner pointed out that faculty members Jennifer C. Romano, MD, MSand Karen M. Kim, MDwere key policy advocates.
The timing of Lucy’s birth was fortuitous in a sense: The American Board of Thoracic Surgery allows two six-week parental leaves during training, one for the first three years of training and another for the last three years. The way Wagner’s furlough was structured (it also included two weeks of vacation) means she will only have to make up four weeks of training.
Once back at work, Wagner adapted to balance the clinical demands with her own biological demands. She pumped in the car on her way to work on the advice of another resident. At work, she didn’t use the lactation rooms often because they weren’t always convenient for her. She didn’t feel like she needed it either, as the process was low-key and her co-residents were very accommodating.
“I usually voiced in a call room or the cardiothoracic resident office. I was really comfortable. I would pump and people would do their jobs beside me,” Wagner said.
Needing to pump in the OR was another story and the most difficult scenario to handle. Heart surgery cases are time consuming (usually at least 6-7 hours) and Wagner had to pump every 3-4 hours in order to maintain her breast milk supply. She had to bathe periodically, but could often wait for the team to shut down or transport the patient to minimize disruption to her learning and ensure continuity of care.
Wagner says the surgeons in attendance have always been accommodating, but there is still room for more education in terms of what to expect, especially in such a male-dominated field.
“It seemed like a lot of the surgeons there didn’t understand how often or how long I would be away. They were okay with that, but we need to make sure everyone knows what’s normal if someone is pumping full time,” Wagner said.
Other scenarios required even more creativity. Wagner once brought her pumping equipment during an organ harvest, but forgot the cooler to keep her milk cold, a necessity when a harvest can take up to eight hours. The transplant team donated the organ cooler for storage.
“When the organ came in, I took my milk out because at that point we only had about an hour to get to the hospital. It was the most unique place I stored a bag of milk,” Wagner said. (Note: There was no risk of contamination of the milk or the organ, which was secured in numerous sealed bags.)
It was one of the many ways Wagner discovered that action followed words.
“The recent review of the care of trainees when they are pregnant and also after pregnancy with these breastfeeding policies highlights the progress that has been made. I’m grateful to the Michigan culture and to Sarah and Ari,” Wagner said.