An Uphill Battle: Challenges Faced by the Breastfeeding and Pumping Gynecologic Surgeon

INTRODUCTION: Breastfeeding has numerous maternal and infant health benefits, and exclusive breastfeeding is recommended for the first 6 months postpartum. The field of obstetrics and gynecology is female-dominated, and the rate of reproductive-aged female gynecologic surgeons continues to rise. Pumping allows one to continue breastfeeding after the return to work but comes with several challenges. Despite the universally accepted importance of breastfeeding, the barriers faced by gynecologic surgeons’ who return to work and pump have not been described or addressed. OBJECTIVE: To characterize the experiences of the breastfeeding gynecologic surgeon, identify common challenges faced, and propose solutions to address these barriers. METHODS: In this cross-sectional study, a novel survey was designed to compare work-related musculoskeletal disorders among pregnant and non-pregnant women. A subset of survey questions focused on breastfeeding. The survey was electronically distributed via a RedCap survey link to listserv members of the Society of Gynecologic Surgeons (SGS) in 2024. All participants were consented electronically, and data was collected via RedCap. Surgeons with breastfeeding experience voluntarily completed an open-ended question sharing their experiences and challenges faced while pumping or breastfeeding upon return to work. The data were analyzed following the procedures of thematic analysis by three independent researchers who each coded the data for themes. Data analysis continued until saturation was reached. The results were discussed, and points of disagreement resolved. RESULTS: There were 115 female survey respondents. The rate of breastfeeding was 95% among women who had given birth, and 91% (n=75) of surgeons continued to breastfeed after returning to work. Of the 66 surgeons who chose to share breastfeeding and pumping experiences, 97% (n=64) reported challenges faced at work and 86% (n=57) faced more than one challenge. Most respondents were fellowship-trained gynecologic surgeons (85%, n=56), and approximately half of participants delivered within the last 2 years (48%, n=32) (Table 1). Analysis yielded six themes and nine subthemes (Table 2). The common themes were time constraints (n=48) and difficulty in balancing OR and clinic schedule with breastfeeding (n=53). Surgeons also reported challenges with logistics of pumping (n=59), with barriers including storage of parts, equipment management, computer access, and lack of appropriate location (Table 2). Individuals suffered from emotional distress (n=14) and negative peer comments or perceptions (n=9). The reliance on expensive wearable/portable pumps was described (n=16). Physical challenges (n=16) included decreased supply, engorgement, and leakage/spillage of milk (Table 2). CONCLUSIONS: Despite the knowledge that breastfeeding is recommended, gynecologic surgeons face challenges pumping at work. This research identified a multitude of barriers to breastfeeding after returning to work, which highlights the lack of protection and support for the breastfeeding/pumping surgeon. These workplace inequities must be addressed. We propose solutions to fully support breastfeeding surgeons, including mandatory decreased surgical and clinical volume to allow for pumping, and dedicated workspaces by the OR with computer access, storage, and the ability to use hospital-grade pumps.