Tips for pumping on the wards
As an aside, I want to emphasize that I know that breast milk is great for babies, but there are a million reasons why a woman might not want to nurse/pump, and that I don't think it is my job in society as a medical professional and a fellow mother (really, just being a human being) to judge the choices of others. There are pros and cons to everything. Every reason is legitimate, in my opinion, because regardless of the reason, most moms put a lot of thought into their decisions and I just don't think it's right to guilt anyone into thinking it should be any other way. There is already enough to worry about with kids, that it would truly just be harmful to make anyone feel as though their choices resulted in a negative outcome for their child. I found nursing to be very challenging for a variety of reasons, and I can't stand it when other moms look down on each other for their child-rearing choices.
Regarding pumping, It wasn't that difficult when I was a preclinical student because it was easy to take breaks (not to mention, I could go home during lunch and pump comfortably and in complete privacy). But on the wards, it was a constant challenge. I used the Medela Advanced Pump In Style (under no circumstances did I ever feel stylish with this thing). I'll try to review it at some point, but it came highly recommended by pretty much every mom I knew. It's pricey, but a solid investment, and it worked well. And boy, was I ready to get rid of it as soon as I was done.
I've tried to put together a few tips that were helpful for me, that I figured out over time. They might not work for everyone, but might come in handy for someone who is just starting out and wants to hear what other people did.
You have to find a place to store your stuff, which can be difficult. I'd try to ask classmates before the rotation started, so I'd have an idea and wouldn't have to stress about it on the first day. Otherwise, I'd have to ask my senior resident, which was kind of awkward to do when I had just met them. Hi, I'm the med student on the rotation this month. Oh by the way, is there a place where I can store my breast pump? If I was on call, I'd store it in the call room. Otherwise, I usually ended up stashing my bag in the corner of the residents' lounge.
In the end, I ended up pumping as little as possible on the wards and then pumping as much as I could at home (to keep supply up). That meant a schedule that could look like this (or worse), if I had to work from 6am to 6pm (pumping at the hospital is in red):
5am, noon, 6pm, 9pm, 1am
And if I was on call (6am to noon the next day):
5am, noon, 7pm, 3am, noon, 3pm, 6pm, 9pm, midnight
So, that's how I avoided pumping more that three times on the wards (that's how challenging it was - I preferred to just wait until I got home). On call nights, I'd try to wait until there was a lull in the workload (hence, the 3am pumping in the ladies' locker room). Never mind that I was totally uncomfortable by the end of the day - luckily, I've never lived far from the hospital, so I could always be home in 10 minutes, and then pump while I (tried) to read to the kids. And I'd often add another session in if my supply seemed low (so I was pumping almost every 2-3 hours at home).
So, you see, I can totally understand why someone wouldn't want to do that, and many times I've looked back and thought that it was totally ridiculous. I was probably not insistent enough on the wards, but as most medical students know, you aren't really in a position to where you can easily request time to yourself. I don't think anyone would reject an adamant request that you need to go pump, but you might find yourself being treated like a nuisance, rather than a team player. And some people are better at making waves than others - I just liked to keep a fairly low profile. It can be a really frustrating system.
I can't wait until I am in a position where I can help a nursing mom by offering her my office (as an attending), or at least my call room (as a resident). And I'd try to point out things like Hey, there's going to be about 30 minutes of downtime, if you'd like to try to pump. Just page me when you're done to find out where we are. And if she expressed worry about missing something, I'd recommend reading up on some diagnosis I knew was coming up in rounds. But truly, it's not good to be stressed while pumping, as that would not help production. All of this amounts to a major design flaw in medical training if you ask me, but that's a whole other story (we don't adhere to our own recommendations). Really - I think I will remember all the crap med students are subjected to, and be sure to not continue that legacy. And I know that puts me as risk of being taken advantage of, but that is a chance I am willing to take. I think I am pretty good at reading people, so I don't think that will happen. Besides, when you treat people with respect, you are much more likely to be respected in return.
Anyhow, here are the tips:
1. Pump right into the bottle if you can. We used Dr. Brown bottles and they worked perfectly. I bought extra screw-on caps to use so that they would not leak.
2. Buy extra breast shields and attachments so you don' t have to wash them every time. I had three sets with A (one included with the pump, and one given to me for each delivery in the hospital), which was about the minimum I'd recommend (it would have been nice to have one or two more sets, particularly for call nights).
3. Pre-assemble the bottles and flanges and pack them into separate gallon-size zipper bags for convenience. I'd carry two or three sets with me every day. After pumping, I'd cap the bottles and put those into the fridge or cooler. I'd pop the used flanges and parts back into the zipper bags to take home to wash. Occasionally, if there was a clean, roomy fridge available (I did this at home too), I'd seal up assembled, partially-pumped bottles in bags and put the whole thing in the fridge to reuse for another pumping session (you have to make sure they won't tip over though). The cool shields were actually quite soothing, and I'd have fewer parts to wash later on. I figured it was probably safe to re-use the parts once, especially if they were refrigerated. I never had any problems with bacteria (at least that I am aware of).
4. Get a hands-free pumping bra so you can write notes/check labs/eat lunch/make calls while you pump. I bought mine at a local store for $30 (expensive, but get used to being gouged on these sorts of things). An apron or cover (or use a sweater or something) can be helpful too.
5. Pump right before starting work, and pump as soon as you get home. It's a total pain, but found that it was infinitely easier to pump at home than it was to pump at the hospital.
6. Pack some pre-written post-it notes in your pump bag to leave a reminder on doors where you might be interrupted.
I often considered pumping in the car (en route to distant locations) but I never did (though I do know one resident who did). I was always worried about spillage or the distraction being too dangerous for the road (Tip #4 would be essential in this case). I'd probably consider it more strongly if I had a regular lengthy commute though, since that may very well be the only time available. Luckily, I don't have to worry about this anymore.