Doctoring While Nursing a Coronababy

My firstborn is a “coronababy.” He had a healthy, uncomplicated delivery during the pandemic, documented over FaceTime for my spouse’s family and mine, as they could not be at the hospital in person. I was granted maternity leave under the Family and Medical Leave Act, and spent most of it happily sheltering in place with our newest family member.

But too soon, my leave was over, and it was time to return to full-time work. I was nervous. I was more sleep-deprived than ever, my body was still recovering from a laundry list of postpartum changes, and I was constantly hearing about new things to worry about (microplastics in bottles?). I had also finally gotten the hang of breastfeeding with the lofty goal of making it to 1 year. That meant that I would have to pump at work — three times a day, every day — all while seeing patients and precepting trainees in clinic.

I had done my research and found a portable pump that, thanks to the Affordable Care Act, had only a small copay attached. Although the pump itself was relatively inexpensive, I quickly figured out that pumping would require a lot of stuff. I would need bottles to store the pumped milk, someplace cold to store those bottles during the workday, and wipes to clean the parts between use. I would need replacement pump parts — valves, membranes, and the right-sized flanges down to the millimeter. I would need a spare charger to power the pump’s battery and hands-free bra so that I could work while simultaneously pumping. And I would need a bag large enough to transport everything I just listed. Nursing might be free but pumping certainly was not.

Working and Pumping

In 2020, the global pump market was estimated to be worth $2.5 billion. North America makes up about 52% of this market share, and a whopping 85% of American breastfeeding women use a pump.

Although the U.S. dominates in breast pumps, we are behind on direct breastfeeding. While more than 80% of babies are nursed at birth, that figure drops by more than half to 35% at 1 year. Physician moms tend to do slightly better at about 40%. For reference, the Healthy People 2030 target is 54.1%.

This is not surprising. A physician’s schedule is demanding and subject to factors beyond our control. More than anything else, breastfeeding for a working parent requires both the time and space. Although the Affordable Care Act mandates that employers provide “reasonable break time for an employee to express breast milk,” the realities of patient care often override any vaguely worded policy statement. In fact, schedule inflexibility and lack of space were the most common reasons for early cessation of nursing among physicians. I knew that my goal would be an uphill battle — but I was determined to at least try.

Telemedicine: An Unexpected Boon

Yet, on my first morning back, I soon found how much our clinic’s embrace of telehealth during the pandemic made a huge difference. With telemedicine, I could pump in my private exam room during video appointments (with the camera strategically angled) and had a place to store all my supplies. Through closed doors, the pump was quiet enough not to bother my colleagues. Only once during a video visit did a patient make a comment about the motor’s noise. “Is the hospital under construction again?” he had asked as I discretely moved the pump away from the microphone. Instead of excusing myself and needing to step away, I could pump while doing most of my job duties, from staffing residents to discussing cases with consultants.

I also discovered how many of my colleagues had pumped before me. A nurse practitioner offered great advice on maintaining my supply. A fellow attending guaranteed that my output would double if I played relaxing music during my pump sessions. One of our nurses made me a laminated sign for my exam room door. Another nurse, newly pregnant, talked pump options with me. Once, when I had forgotten the lids to my storage bottles, a coworker brought me sterilized urine specimen cups. Though we were separated for safety, I found an informal community of professional moms in healthcare who understood exactly what I was going through and appreciated my jokes about feeling like a dairy cow.

Pumping is just one of the numerous benefits of telemedicine. It is a shame that it took a pandemic for the medical community to take advantage of virtual technology. COVID-19 has changed medical care forever, and telemedicine is here to stay, for the better.

My son is now almost a 1-year-old, and I am proud to report that we will make it to our breastfeeding goal. Soon, I will (happily) hang up my pump. It is hard enough to be a physician and a parent, but I am grateful that I had telemedicine to help me feed my child on my own terms.

Eunice Zhang, MD, MPH, is an assistant professor in the Department of Internal Medicine at the David Geffen School of Medicine at UCLA.