Occupational Stress and Coping During a Public Health Emergency: A Mixed-Methods Approach to Understand the Experiences of Lactation Professionals in Clinical Settings

Introduction: During public health emergencies, such as the coronavirus 2019 pandemic, breastfeeding is still the recommended feeding option, and mothers and babies may need additional support to reach breastfeeding goals. Pandemic-related, clinic-level restrictions posed new challenges for postpartum mothers and their healthcare teams, including lactation professionals (LPs). The pandemic and subsequent restrictions may have impacted lactation professionals’ work-related stress and limited their ability to provide lactation support. Coping strategies to mitigate occupational stress can be useful in preventing adverse outcomes for both the provider and the patient. The need for continuous support for this profession of healthcare workers is paramount. Objective: To measure occupation stress, explore specific stressors and coping strategies, and understand how pandemic-related workplace policies may have impacted lactation professionals’ ability to provide lactation services to postpartum women and their babies. Methods: This study used a mixed methods approach to achieve its aims. A cross-sectional, online survey was disseminated to evaluate hospital and clinic-based lactation professionals’ experiences working with postpartum women and their newborns during the COVID-19 pandemic. The study also implemented a qualitative component, using a key informant interview format, to identify specific stressors and coping strategies, and understand how lactation services were impacted. Appropriate descriptive and inferential statistics were performed. Qualitative data was analyzed using reflexive thematic analysis techniques. Results: The sample included 1373 healthcare professionals. Most lactation professionals (91.8%) surveyed reported moderate to high levels of perceived stress. Some specific stressors included the implementation of new policies, wearing PPE, employment changes, and transitioning to telehealth. LPs incorporated problem management, emotional regulation, and meaning-based coping strategies to mitigate stress. Changes to clinical policies negatively and positively impacted the provision of lactation services. Conclusions: During public health emergencies, lactation professionals, particularly those who have dual role responsibilities, may benefit from additional support. Interventions to support this population should be informed by coping strategies identified in this study. To protect breastfeeding during public health emergencies, more research is needed to understand the impact of stressors on the provision of service, the effectiveness of coping strategies to reduce perceived stress, and the potential role of geographic location on policy implementation and adherence.