Exploring Workplace Barriers Faced by Breastfeeding PAs

Summary

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JAAPA Podcast Episode Summary

Episode Title: Exploring Workplace Barriers Faced by Breastfeeding PAs
Date: April 24, 2024
Host: JAAPA (Kim and Martine)
Guest: Lindsay (PA, Researcher and Author on Breastfeeding PAs)

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Episode Overview

This episode of the JAAPA Podcast delves into the unique and often challenging landscape faced by physician assistants (PAs) who breastfeed while working. Featuring guest expert Lindsay—whose recent research explored barriers for breastfeeding PAs—the conversation covers legislative updates, personal experiences, literature gaps, key findings from the newly published study, and actionable recommendations for workplaces and future research. The overall tone is candid, empathetic, and supportive, with the hosts and guest sharing personal stories to underscore the need for continued advocacy and awareness.

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Key Discussion Points & Insights

1. Setting the Stage: Legislation & Personal Experience

• Introduction of Federal Protections:

  • The Pump Act (2022) and Fair Labor Standards Act mandate reasonable breaks and provide protected, non-bathroom spaces for lactating employees, extending protection up to one year after a child’s birth (00:06).
  • These laws newly cover many employees, including salary-exempt positions common among PAs.

• Personal Journeys:

  • Lindsay, Kim, and Martine describe the logistical, emotional, and physical challenges of balancing breastfeeding and patient care, often pumping in cars, offices, or non-private spaces (01:11, 02:48).
  • Martine relates: "I remember pumping in the car ... on my way down to work and on my way back ... Because if I didn't do that, forget it" (02:48).

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2. Benefits of Breastfeeding (For Baby & Mother)

• According to Lindsay and established guidelines:
  • Infant Benefits: Reduced risk of respiratory infections, otitis media, diarrhea, asthma, obesity, diabetes, childhood leukemia, SIDS, and infant mortality.
  • Maternal Benefits: Lower risk of type 2 diabetes, hypertension, breast, ovarian, and endometrial cancers.
  • "The World Health Organization states that optimal breastfeeding could save the lives of 820,000 children under the age of five" — Lindsay (04:19).
  • Despite these benefits, sustaining breastfeeding while working is notably challenging.

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3. Challenges & Barriers for Breastfeeding PAs

• National Trends: Less than a third of US infants are exclusively breastfed at six months (05:02).

• Common Barriers Identified:

  • Lack of protected time and private space to express milk.
  • Absence of supervisor/colleague support.
  • Administrative and workflow constraints; lack of adequate milk storage.
  • Stress and demanding, unsupportive work settings.

• The PA Context:

  • 71% of PAs are women, with a median age of 38—making workplace breastfeeding a particularly salient issue in the profession (06:11).
  • Before Lindsay’s study, existing research focused mainly on physician mothers, with similar reported struggles (06:26).

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4. Lindsay’s Study: Survey Methods & Key Findings

• Survey Launch:

  • Distributed via the PA Moms AAPA Special Interest Group Facebook group (over 17,000 members) using convenience sampling (07:43).
  • Survey adapted from previous research on physician mothers.
  • Covers intentions, workplace experiences, support, and decisions to stop breastfeeding (08:26).

• Notable Findings:

  • High initiation: 96.3% began breastfeeding, surpassing national averages.
  • Drop-off: Only 54.8% breastfed to 12 months, compared to 76.8% who intended to.
  • Primary barriers: Lack of time, space, and support.
  • 27.6% of PA moms reported quitting breastfeeding due to workplace demands (09:21).
  • Quote: "Despite our PA education and breastfeeding intent, workplace factors have a sizable effect" — Lindsay (09:21).

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5. Specialty, Environment, and the PA Profession

• Specialty Impacts:

  • Anecdotes suggest specialty (hospital medicine vs. outpatient) affects breastfeeding duration, but Lindsay's data did not find a specific statistical link to duration (13:06).
  • "The study didn’t take into account that PAs are able to switch specialties ... Future studies could probably take some of that into account" — Lindsay (13:06).

• Comparisons to Other Health Professionals:

  • PA data closely mirror trends among physician mothers: high initiation, early cessation due to workplace barriers (14:26).

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6. Recommendations for Employers & Next Steps

• Supporting Breastfeeding Employees:

  • Sufficient protected break time and access to a private, non-bathroom place to pump.
  • Foster a supportive environment and promote flexible scheduling (14:59).
  • Employees: Know your rights under the Pump Act and state laws.
  • Quote: "Workplaces need to create supportive environments for breastfeeding mothers and flexible schedules so that ... PA moms have adequate time to meet their workplace obligations as well as expressing breast milk" — Lindsay (14:59).

• Advocacy:

  • Open dialogue with employers is crucial; awareness can prompt policy and culture change (18:55).

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7. Looking Forward: Research and Legislative Needs

• Future Research Suggestions:

  • Analyze the impact of specialty-switching.
  • Compare inpatient vs. outpatient environments.
  • Study state-specific law effects (e.g., Washington protects up to two years vs. federal one year standard).
  • Repeat research post-Pump Act implementation for up-to-date insights (16:51).

• Quote: "Future studies ... could examine how different state laws affect breastfeeding duration." — Lindsay (16:51)

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Memorable Quotes & Moments (with Timestamps)

• Personal Sacrifice:
  • Martine: "During my break, that's all I did ... breastfeeding, doing my lunch break or charting while breastfeeding, where I was seeing patients was also my office." (02:48)
• Workplace Struggles:
  • Lindsay: "I had to pump in patient exam rooms that didn’t have locking doors. Many times I was locked in on, so it definitely lacked privacy." (01:11)
• Practical Solutions:
  • Lindsay: "Employers should provide ... adequate place for expressing breast milk. Workplaces need to create supportive environments." (14:59)
• On Legislation:
  • Lindsay: "The result of this act is that workplace breastfeeding protection is now extended to many employees who were previously not protected." (15:30)
• Aspirational:
  • Martine: "I agree with Kim. I have a daughter as well, so hopefully by the time they grow up and are ready to enter the workforce, things will be way different." (19:11)

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Important Segment Timestamps

• 00:06 — Introduction to breastfeeding legislation and guest
• 01:11 — Lindsay’s personal breastfeeding at work experiences
• 02:48 — Martine details her own workplace breastfeeding journey
• 04:19 — Lindsay discusses breastfeeding health benefits
• 05:43 — Workplace barriers and success factors
• 07:43 — How the survey was conducted via PA Moms group
• 09:21 — Key study results: intent vs. real breastfeeding duration
• 13:06 — Discussion on specialty impact and study limitations
• 14:59 — Recommendations for employers to promote breastfeeding
• 16:51 — Suggestions for future research and impact of state/federal laws
• 18:55 — The importance of open communication with employers and knowing one’s rights

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Conclusion

The episode’s meaningful, firsthand narratives alongside Lindsay’s novel research underscore the persistent challenges—despite legislative gains—faced by breastfeeding PAs, especially concerning workplace support, environment, and culture. There is clear momentum for improvement, from both an organizational and legislative standpoint, with a call for further research and open advocacy to shape a more supportive future for all working parents.

Resource Note: The hosts also mention the “PAs for Women Empowerment” caucus and its infographics for workplace advocacy and education.

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Transcript

[Martine]

Foreign.

[Kim]

There are several health benefits related to breastfeeding. However, breastfeeding is labor and time intensive, and lactating parents often struggle to continue breastfeeding after they return to work. In 2022, the Fair Labor Standards act and the Providing Urgent Maternal Protections for Nursing Mothers act or Pump act set forth protections for nursing employees. Examples include a reasonable break, a place other than a bathroom that is shielded from view to express milk, and that is right available up to one year after the child's birth. This federal legislation was a game changer and several states have enacted similar legislation. Several questions may be coming to mind. One may be how does it apply to me as a PA or a PA student? Luckily, we have a fantastic guest joining us today who is going to help us explore barriers experienced by breastfeeding. TAS Lindsay, welcome to the podcast. We really enjoyed your recent publication in japa. Can you tell a little bit about your past experience, where you were clinically and then what inspired you to do your research?

[Lindsay]

Hi Kim and Martine, it's great to be here. Thank you for the excellent introduction. My past experience with breastfeeding and pumping at work wasn't without its challenges, but also wasn't as difficult as what others have been through. During my breastfeeding journey, there were multiple times I had to pump in patient exam rooms that didn't have locking doors. Many times I was locked in on, so it definitely lacked privacy. I also didn't have the support of supervisors, but thankfully my colleagues were very understanding clinically. I worked in family medicine for 12 years before recently transitioning into psychiatry for the past two years. I found my niche and I am happy to be practicing in a specialty that I truly enjoy. The inspiration for the research actually came during late night breastfeeding sessions with my second son, rolling social media trying to stay awake. While doing this, I came across multiple posts from PA moms asking questions about how they could find the time to pump at work or detailing challenges with work administrators, colleagues, et cetera, and overall feeling very discouraged trying to pump while working.

[Kim]

Lindsey, I truly empathize with your experience. I know Martine does as well. We're both moms. I've had many of those middle of the night pumping sessions or breastfeeding sessions where I just start to think about a lot of things. I had my first child during the COVID pandemic and so my first experiences in motherhood and breastfeeding were very isolating. I would visit the lactation room at work at least twice a day, spending time alone, feeling that the challenges I was encountering were unseen. Thank you for bringing this conversation to light. I'm impressed by the community of mothers and fathers who are advocating to implement and support structures for working parents.

[Martine]

The American Academy of Pediatrics recommends exclusively breastfeeding for six months and complementary breastfeeding for two years. I know myself for my both of my kids I tried my best to do that. And for my first one I did for 18 months while working full time. It was a challenge and I was working 45 minutes away from home to an hour in my commute. And I remember pumping in the car. I would connect my pump and connect on my way down to work and on my way back, not counting while at work, to make sure I could continue keeping up with my supply. Because if I didn't do that, forget it. So before working the early morning, I would breastfeed, pump in the car, pump on my way while in traffic. So it was very challenging. Did I get all that because I believe in the benefits of breastfeeding and I thought it was worth the sacrifice, worth all the lifting up already and never had a break. During my break, that's all I did. Breastfeeding, doing my lunch break or charting while breastfeeding, where I was seeing patients was also my office. So I would close the door and between patients breastfeeding. So I remember those days. That was with my first one. So with all that said, I myself believe in breastfeeding as for as long as you can. Although it's challenging for people if you aren't in the workforce. For women in the workforce, and especially if you work in the in the clinical setting, it's not always easy to find a private place to breastfeed like you were mentioning. So what are some of the benefits of breastfeeding? You can tell us that makes us jump through all those hoops?

[Lindsay]

That's a great question. There are many benefits to breastfeeding, both for baby and for mom. According to the aap, breastfeeding reduces an infant's risk of respiratory tract infections, otitis media, acute diarrhea, asthma, atophic dermatitis, inflammatory bowel disease, obesity, diabetes, childhood leukemia, sudden infant death syndrome, and infant mortality. In addition, the World Health Organization states that optimal breastfeeding could save the lives of 820,000 children under the age of five. Finally, mothers who breastfeed have a lower risk of type 2 diabetes, hypertension, breast cancer, ovarian cancer, and endometrial cancer.

[Martine]

As a mom who has breastfed, I can attest that it is hard to continue for any length of time. Even women who can do three months still a very big deal. In your article you cite that in the US less than 1 third of infants are exclusively breastfed at 6 months of age. And I can understand that because now we are in the workforce. Women are not just at home, they not stay at home where you can do all that. So breastfeeding for any length of time while you're working full time and adding to that taking care of other siblings applies to all of those parents who are doing it. What are the challenges they face and what are some factors or themes that can help them to be successful in their efforts, in your opinion?

[Lindsay]

Yeah, that's another great question. In my research, there are some common themes in some systematic reviews involving just working mothers in general about continued breastfeeding after returning to work. Women who had access to break lactation rooms and supportive colleagues were more likely to continue breastfeeding. Women that didn't have those support structures in place had a lot more difficulty continuing to breastfeed when they returned to the workplace.

[Martine]

71% of PAs are women with a median age of 38. It seems like there is a potential that our profession includes a lot of mothers and fathers. Prior to your research, what was known about breastfeeding within the PA profession?

[Lindsay]

I'm glad you asked. In my literature review, there were no published articles pertaining to PAS and breastfeeding challenges after returning to work. There were, however, some published studies of physician mothers who explained experience similar challenges as other working mothers when returning to work. The most common barriers identified among breastfeeding physicians included inadequate time to pump, inadequate location to pump, unsupportive teams working too many hours, low milk supply, stress, and inadequate storage for breast milk. Differing practice specialties and work environments also contributed to the difficulties that physician mothers encountered, and this gap in the literature is what prompted my interest to conduct a study of PA moms.

[Kim]

Very interesting and your idea is certainly novel and I'm glad that you're looking into it. We'd love to learn more about the methods behind your research. To gather your data, you sent a survey to PA Moms and ended up recruiting over 700 participants and included 540 moms and an extension 1002 children in your study. PA Moms is a AAPA Special Interest Group. At the time of this recording, their Facebook page has almost 17,000 members. Why did you select this platform to launch your survey?

[Lindsay]

I used the platform to launch the survey using a sampling method called convenience sampling. With this type of sampling, it increases vowels, but I often hear this type of gambling method due to the ease of having access to the survey. If I was already a member, it necessarily reviewed the contact the admins of the group and say hey, can you try to promote this posting to get to recruit more members to participate in the survey? As a PM on where my selected population of interest has a study, it was just an easy way to get this out to as many people as possible to fill out the survey for the research.

[Kim]

Tell us more about this survey, what questions were included and how did you develop it?

[Lindsay]

So the survey was not my own. It was actually adapted and previously used by Dr. Miriam Satari and colleagues for a similar study involving physicians. Participants in the study completed 40 questions online evaluating their breastfeeding intentions and their experiences breastfeeding after returning to work. A majority of the questions used a Likert scale to evaluate whether PEs were allowed protected break time and private space for expression of breast milk. Questions about support from colleagues, supervising or cooperating physicians, employers and staff were also included. Further questions evaluated whether PA mothers quit breastfeeding early because of workplace demands. And lastly, there were a few open ended questions exploring underlying themes or patterns that encouraged or discouraged a working PA mom from continuing to breastfeed.

[Kim]

So we're all curious. What did you find?

[Lindsay]

I found that PA mothers in the study had high breastfeeding initiation rates at childbirth. Based on the Healthy People 2030 data and objectives, PA moms surpassed the general population rates of exclusive breastfeeding to 6 months and any breastfeeding until 12 months. However, Pa moms just barely surpassed these objectives. The barriers identified that impacted breastfeeding duration in the study included lack of time and space to express breast milk, as well as lack of support from colleagues, supervising or collaborating physicians and support staff. The most important finding, I think, was that despite TA moms having high breastfeeding initiation rates of 96.3%, only 54.8% were able to breastfeed until at least 12 months, compared to 76.8% of PA moms having the intention to breastfeed for this duration. The difference between the breastfeeding intent and actual breastfeeding duration, along with the workplace barriers associated with breastfeeding duration, suggests that despite our PA education and breastfeeding intent, workplace factors have a sizable effect on this. And lastly, 27.6% of PA moms in the study indicated that they quit breastfeeding because of the workplace demand.

[Martine]

Well, I couldn't agree more with your findings, Lindsay, because me personally, my experience concurs with these findings because for my daughter I breastfed for 18 months. I was working outpatient family medicine, so I had a private space on my own. It was easier, although I had to be commuting a long time. I was breastfeeding in my car as well for my son. I did for a little bit, I think below 12 months, but I didn't go as far as 18 months because I was in hospital medicine. So Kim knows also how it is working in Hospital Medicine. 12 hour shifts. So you would have to spend most of your day pumping instead of breastfeeding. They had a very little time of really breastfeeding. And there's no private space. It's hospitalist. We are all in the same room. The hospital doesn't necessarily have a space where you could breastfeed. I didn't have that in the hospital where I was at. So I remember I was using those three knee cups. And as I was charting in the room and I had one hospitalist. These are male hospitalist, as a matter of fact. And I was breastfeeding, like, mindless. Now I'm thinking about it. I'm like, what were you thinking? Was my mommy brain? Because you could hear the pump. In my time. My son is now nine years old. We didn't have those silent pump. And I know now they're all fancy, but you could hear the. While I'm just. I'm charting. And he would be like, what's that noise? I'm like, oh, that's my. I'm very speedy.

[Kim]

I'm.

[Martine]

I'm pumping. That's my pump. He's like, okay, because I had my pump connected. You could hear the noise. He's charting. He's like, okay, But I'm now thinking about. I'm like, oh, my God, what was I doing? I didn't think about, oh, maybe I shouldn't do it because it was those three me cups. And after I would go to the bathroom to remove them and pour the milk. I had to go to the bathroom to do that because I always had someone with me. So the specialty really will impact, especially if you're in a hospital system and you don't have a. And then depending on how busy you are. I know being a hospital, they say was very hard, but one of the hospitals, they opened those rooms. Mother. I think they call them lactation rooms for breastfeeding moms. So they had a recliner and a very small space where you could go and pump. But that happened after I. So with that said, that's my little experience. What role does the specialty within the PA profession play? In influencing breastfeeding duration according to your findings?

[Lindsay]

Yeah, this is one of the questions that I had because I had also noticed a very similar pattern among the kind of social media posts and a lot of it was ERPAs or surgical PAs who would describe not having any time in their shift. How could they do this? And so I had a very similar question. Does specialty have an impact on breastfeeding duration? But unfortunately in my study there was no statistical association that was found between specialty and any breastfeeding duration. However, there was a significant association between specialty and exclusive breastfeeding duration was one of the more ambiguous results of the study. But unfortunately the study didn't take into account that PAs are able to switch specialties. So that could explain some of these more ambiguous results and that future studies could probably take some of that into account and delve into the actual specialty piece a little bit more. Since I was also a little ambiguous on that.

[Martine]

That would be a good study to make. I agree, because I definitely think it will impact how, you know, we go about breastfeeding, what your day to day work looks like. So how did these findings compare to physicians and other healthcare professionals? It must be in the same boat as us. It cannot be as different, right?

[Lindsay]

Yeah. So the findings were very similar to our physician mom colleagues in that physician moms also had very high initiation breastfeeding initiation rate, but also they did not meet their breastfeeding goal duration. Very similar to PA moms.

[Martine]

I think they have a bigger population. So I think we can extrapolate and think it's probably the same for us. You've identified several areas of opportunity. What can employers do to promote breastfeeding? And also how can we start to have these conversations with our employers?

[Lindsay]

Yeah, this is such a great question. To promote breastfeeding, employers should provide all women, including PA mothers, with sufficient time and an adequate place for expressing breast milk. Workplaces need to create supportive environments for breastfeeding mothers and flexible schedules that can carve out time away from patients or procedures so that looking ta moms have adequate time to meet their workplace obligations as well as expressing breast milk. I think the first step to having these conversations with employers is to first know your rights and know the laws that protect breastfeeding mothers. After this study was completed was when the punk act that was mentioned earlier was passed in December 2022. So before this study was done, the Pump act was not in effect. The result of this act is that workplace breastfeeding protection is now extended to many employees who were previously not protected by the Prior legislation, in addition to the protections that Kim mentioned earlier, the legislation now specifically includes exempt employees, which means PA moms looking salary exempt positions are now included in these protections.

[Kim]

It's very interesting. I had a baby before the Pump act and after the Pump act. And while my employer does have very good accommodations for breastfeeding parents, I did notice a difference in the support that I had from my colleagues after the Pump Act. I thought it was more open to talk about, I need to go pump. And they'd be like, okay, let me help you cover your patients. So thinking about that and that the landscape has changed, what do you think the future holds in store for working parents who are breastfeeding? You know, I always think, I have a daughter, I want it to be better for her. What are some areas that researchers should look at to be able to further first address the challenges related to breastfeeding and then help to make it better?

[Lindsay]

Yeah. So future studies should account for, like I had said before, that PAs are able to switch specialties to determine if there's a significant impact on PA specialty and breastfeeding. It would also be helpful if future studies had further delineation between inpatient and outpatient studies. I think there are specialties. I think there's a big difference between the two and being able to have that time. My study also did not consider state specific breastfeeding laws, which can provide workers breastfeeding protection above and beyond the federal law. So I currently work in Washington, and Washington breastfeeding laws are over and above what the federal laws are. You have protection up to two years instead of a year, so you can pump at work for up to two years, which is fantastic. So future studies could examine how different state laws affect breastfeeding duration. Other recommendations for future studies would include to include more raw numerical data to allow for more complex statistical analysis. And definitely hiring an outside statistician would be beneficial because I am not a statistician by any means. And lastly, future research would be helpful in determining the impact of the new pump act on PAs and breastfeeding duration. Since this was done beforehand, maybe repeating the study or a similar study now that the Pump act is in effect could help determine how this act has been beneficial or not beneficial for PA moms.

[Martine]

That's great, Lindsey. Are you telling us all new moms we should move to Washington to work?

[Kim]

Very.

[Martine]

That's very interesting. And I agree with you. I had my kids before the contact, so it's all new to me. I'm really amazed by all the strides we have Made so far because I didn't have that at all. Like I said, in the hospital where I work, they didn't even have a space dedicated for that. So now you do. So everything has changed. And I'm in Florida.

[Kim]

Yeah. Can I add, too? Like, one thing that I learned after the pump act is that we all need to talk about it, too. It's not necessarily where the employer is even aware of it. You bring it to them and say, hey, look, this is what happened. So there's something that we all, as PA Moms, can gather forward to bring this information to our employers.

[Martine]

I agree. And this is something I was afraid of talking about. It's like I was breast. I was pumping. I was hiding to pump, if you want. I didn't want people knowing that I was pumping, except, you know, I would go to the bathroom or I would just close my door. It's not something that I voiced. I didn't say I need this time. I just was trying to fit it in into my day, into my work day without disrupting the flow. Nobody covered me. I didn't ask for coverage. I didn't say whatever. I just tried to pump while I was charting on my own time without even having to mention. I don't even know if, you know, everyone knew I was even pumping at work. So now it should be open. They should know you just had a baby. You're going to have time to pump. And I really like that. And I agree with Kim. I have a daughter as well, so hopefully by the time they grow up and are ready to enter the workforce, things will be way different. We'll be advancing that sentence. Well, that was a very great conversation. Thank you, Lindsay, for this important discussion. And I can tell we are all excited about this discussion. As moms and working moms, you have taught us much about the challenges faced by breastfeeding parents. Now, Kim and I, we know we're not alone. We were not alone in that battle because that was very hard. You have to really want it to be able to do it. It was a big sacrifice for me. I remember it's because I pushed through because that's what I wanted for my kids. And we hope our listeners will take this information forward with us as we care for our patients and communities. And I want to mention, if we PAS for Women Empowerment, which is an AAPA caucus, they have infographics. You will find the link in our podcast summary. I encourage you all to look at those infographics. You can bring them to your workplace, know your rights, you know the Pump act, you have to know your rights. As always, please be sure that you are following JAPA on social media I AAPA Online. That's all spelled out and let us know your thoughts about the topics. Please Went over today and until next time.

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