Guidelines for Supporting Lactating Women
Residents, Fellows, Medical Students and Healthcare Workers at LAC+USC

I. Introduction: We have developed this guideline in order to support the wellness of lactating residents and fellows. We are committed to protecting the health and wellbeing of our house staff as well as healthcare workers and have prepared this document to serve as a guide and show of support to lactating residents and fellows. 

II. Challenges faced by lactating residents and fellows:

1. Health and wellness of lactating resident/fellow:
   -Infrequent or insufficient milk expression can lead to plugged ducts, mastitis, sick days, and/or decrease in milk supply.
   -Significant time spent away from young child can lead to stress.
2. Cultural Expectations of lactating residents and fellows:
   -Accommodations and expectations for lactating residents are not explicitly discussed, leaving ambiguity for the both lactating and non-lactating residents to navigate.
   -Fatigue, burnout and work compression is a common result.
3. Resident/fellow commitment to clinical obligations:
   -Inability to schedule lactation breaks in advance, given unpredictable nature of clinical practice, can potentially result in infrequent or insufficient pumping.
4. Access to lactation facilities:
   -There is a lack of lactation facilities that have capabilities of refrigeration for milk storage and sinks.
   -Existing lactation rooms are not close to clinical responsibilities

III. We ask LAC+USC for their commitment & support to lactating women by:

1. Building an additional lactation facility on the main campus, in the 5th floor of DNT, near the surgical area.
2. Distributing and updating this “Guidelines for Supporting Lactating Residents" prior to maternity leave.
3. Striving to create a welcoming and inclusive environment for a diverse work force.
4. Respecting that different women require different intervals between expression and take different amounts of time, and will work with each resident with a foundation of mutual trust and respect to foster an individually appropriate pumping schedule, without adherence to precedent set by others.

IV. We propose the following to be the responsibilities of lactating residents, fellows, and other healthcare team members:

1. Ongoing commitment to patient care and careful consideration for clinical continuity when determining appropriate times to express milk
2. Advanced notice, by first day of a new rotation, to attendings and co-residents/fellows co-interns on the service, if she will require time to express milk upon return from maternity leave.
3. Clear communication with program director, attendings, clinic administrative support and colleagues regarding specific needs for lactation (time interval, specific concerns).

V. We propose the following specific strategies to promote opportunities for expressing milk:

1. Resident and fellows with inpatient/ICU responsibilities:
   • The resident/fellow will attempt to schedule pumping in order to be minimally disruptive to patient care and team rounds. On inpatient/ICU services it is inevitable that there may be conflict with rounds; in this case, the team should strategize how best to support lactating resident.
   • Rooms/locations for expressing milk will be designated and prioritized as lactation rooms for any team with a lactating resident/fellow. 
   • Clear communication by lactating resident/fellow with team members (co-residents, co-fellows, attendings, PA, NPs) regarding pumping needs.
2. Residents and fellows in clinic:
   • Lactating resident/fellow will be allowed to pump during clinic sessions at a reasonable interval. Lactating resident/fellow will not leave during a patient encounter.
   • Lactating resident/fellow may block 30 minutes within each half day clinic to express milk. A full day clinic may block 30 minutes in both the morning and afternoon clinics.
3. Residents and fellows in conference/mandatory academic activities:
   • If notified in advance of mandatory activities such as the in training exam, the Program will accommodate a resident's/fellow's need to express milk by extending exam time to allow for walking to and from lactating rooms, plus time pumping.
4. Residents and fellows in operating room:
   • Lactating resident/fellow will notify attending surgeons on each service that they will require lactation breaks during prolonged procedures. 
   • Lactating resident/fellow will minimize interruption to operating team by pumping before or after cases whenever possible and will not leave during critical portions of the operation.
   • Lactating resident/fellow will reach out to available team members to serve in their absence and will minimize their time out of the operating room.