Supporting Lactation Within an Academic Anesthesia Department: Obstacles and Opportunities

Titler, Sarah S; Pearson, Amy C.S.

doi:10.1213/ane.0000000000004899

Cited by 11 publications

(12 citation statements)

References 8 publications

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“…For surgical suites with > eight-hour workdays like the studied hospital, deliberately prolonging turnovers would be irrational (costs vastly greater than an extra anesthesia provider for breaks) and inconsistent with (in this context, appropriate) biases [22]. Before our study, it was known also, qualitatively, that the choice of anesthesia assignments can facilitate the approximately 30 minutes needed for breast milk pumping sessions [12]. For example, it was clear that providing such relief would be practical at a large, inpatient surgical suite with many long (e.g., seven-hour) cases but not at a freestanding gastroenterology clinic with many short duration (e.g., 30-minute) cases.…”

Section: Discussionmentioning

confidence: 99%

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Percentages of Cases in Operating Rooms of Sufficient Duration to Accommodate a 30-Minute Breast Milk Pumping Session by Anesthesia Residents or Nurse Anesthetists

Titler¹,

Dexter²,

Epstein³

2021

Cureus

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Introduction: Accommodating breast milk pumping sessions is required by US federal statute, but fulfillment is challenging for US anesthesia providers (e.g., anesthesia residents and nurse anesthetists). Considerations of good anesthesia practices (e.g., being present for critical portions of cases, including induction and emergence) create limits on which procedures are suitable for such relief. Our objective was to quantify the minimum percentages of cases for which there could reliably (≥ 95%) be at least 30 minutes during the surgical time when the anesthesia provider could receive such breaks. Methods: We studied all surgical cases performed at an anesthesia department over four years, including its inpatient surgical suite, pediatric hospital, and ambulatory surgery center. The 5% lower prediction bounds of surgical times (surgery or procedure start to end) were calculated from three years of historical data (October 1, 2016, to September 30, 2019) based on two-parameter lognormal distributions. The prediction bounds were compared to actual surgical start times during the next one year (October 1, 2019, to September 30, 2020). We considered the interval available for a breast milk pumping session during a case to be from 15 minutes after the start of the surgical time (to allow completion of initial documentation, other activities, and hand-off to the relieving anesthesia provider) until the end of the surgical time. Results: The lower prediction bounds were accurate, with 4.9% (4.6% - 5.2%) of future cases’ surgical times being briefer, matching the nominal 5.0% rate. Applying these bounds, approximately 39% of cases (99% confidence interval 39% - 40%) were reliably of sufficient duration for the anesthesia provider delivering care in that one operating room to receive a 30-minute break for breast milk pumping session between 15 minutes after the start of surgery and procedure end. This percentage (39%) was substantially less than the 72% of the surgical times that were observed, in retrospect, to be sufficiently long because the lower 5% prediction bounds accounted correctly for the uncertainty in the duration of each case. The observed 39% prevalence was significantly fewer than half the cases (P < 0.0001 vs. 50%) suitable for such relief. Conclusions: Individuals making operating room assignments for anesthesia providers need to consider the 5% lower prediction bounds of surgical times for cases in the room when making such assignments for women who require time for breast milk pumping sessions. Such considerations will generally result in assignments to rooms with one or more long-duration cases. Such a strategy may involve changes in preferred assignments for the anesthesia providers and alteration in the order of rotations for anesthesia residents (e.g., palliative care rotation rather than transition to practice at a pediatric ambulatory surgery center). When making room assignments for anesthesia providers who are breastfeeding, our results show that the 5% lo...

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Section: Discussionmentioning

confidence: 99%

“…Demographic data of the historical and contemporaneous periods are shown in Table 1 [12]. The table is organized by counts of cases, not OR days.…”

Section: Data Analyzedmentioning

confidence: 99%

Percentages of Cases in Operating Rooms of Sufficient Duration to Accommodate a 30-Minute Breast Milk Pumping Session by Anesthesia Residents or Nurse Anesthetists

Titler¹,

Dexter²,

Epstein³

2021

Cureus

View full text Add to dashboard Cite

show abstract

“…Our trainees should be aware that although the University of Iowa has designated lactation space at each surgical suite, 5 while most Iowa facilities do not. This was especially pronounced in smaller hospitals and ambulatory surgery centers.…”

Section: Discussionmentioning

confidence: 99%

“…(2) Include in your e-mail the minutes walking time from the busiest operating room to the nearest available lactation space. Attach JPG cell phone picture(s) showing: (3) the designated lactation space, (4) exterior signage (eg, 'in use'), (5) interior lock on the door or not, (6) cleaner disinfectant supplies in room to sanitize between users, (7) closest electrical outlet and extension cord if needed, (8) chair, and ( 9) table or counter. You can 'Share' pictures one at a time from the same e-mail address."…”

Section: Developmentmentioning

confidence: 99%

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Low Prevalence of Designated Lactation Spaces at Hospitals and Ambulatory Surgery Centers in Iowa: An Educational Tool for Graduates’ Job Selection

Titler¹,

Dexter

2021

A&A Practice

Self Cite

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Many anesthesiologists and nurse anesthetists want to continue breastfeeding their babies when returning to work from maternity leave. The cornerstone of breast milk supply maintenance is breast milk pumping sessions at regular intervals. These breast milk pumping sessions require time and private space for lactation. We surveyed Iowa hospitals and ambulatory surgery centers and created an educational spreadsheet to guide inquiry and postgraduate job selection of our anesthesiology residents and nurse anesthetist students (eg, when considering future family planning). The survey and spreadsheet showed a low prevalence of dedicated lactation space for anesthesia practitioners near the surgical suites.

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Alleviating stressfeeding in the emergency department: Elucidating the tensions induced by workplace lactation space issues

Moulton,

Izuno,

Prendergast

et al. 2024

JACEP Open

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ObjectivesWomen remain underrepresented in the emergency medicine (EM) workforce, academic EM, and institutional leadership. In order to support women physicians in EM, we must explore factors that contribute to attrition and workplace satisfaction. For example, tensions between workplace and familial roles are important to consider as women navigate careers in EM. The logistics and stressors of workplace lactation pose a particular challenge during an already stressful time for a new mother returning to work in a busy emergency department (ED), but limited empirical data exist regarding this experience. We aimed to explore the stressors associated with workplace lactation spaces in order to better inform the creation of lactation spaces for individuals working in EDs.MethodsOur team used an exploratory qualitative design to investigate lactation‐specific stressors and understand their relationship to individuals’ needs when lactating in EM workplace environments. A total of 40 individuals were interviewed, highlighting post‐pregnancy return‐to‐work (RTW) experiences of medical students, residents, advanced practice professionals, nurses, fellows, and faculty. Interviews were coded and analyzed using thematic analysis.ResultsWe identified both tangible and intangible characteristics of lactation spaces that contribute to stress for lactating individuals. Additionally, we discovered that participants frequently noted a desire to work simultaneously while pumping in order to feel they were self‐actualizing in their dual roles of parent and clinician. Among tangible items, access to a computer within lactation space was a key driver of ability to fulfill dual roles. Among intangible characteristics, we identified three distinct, yet interrelated, subthemes, including the need for lactation spaces to be respectful of individuals’ time, privacy, and general health and well‐being.ConclusionsThis study suggests that meeting basic lactation needs with thoughtfully designed lactation spaces can empower individuals in their roles both as a lactating parent and a clinician. EM leadership can evaluate existing lactation spaces to ensure they meet the tangible and intangible needs of lactating physicians, trainees, advanced practice professionals, and nurses.

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Supporting Lactation Within an Academic Anesthesia Department: Obstacles and Opportunities

Cited by 11 publications

References 8 publications

Percentages of Cases in Operating Rooms of Sufficient Duration to Accommodate a 30-Minute Breast Milk Pumping Session by Anesthesia Residents or Nurse Anesthetists

Percentages of Cases in Operating Rooms of Sufficient Duration to Accommodate a 30-Minute Breast Milk Pumping Session by Anesthesia Residents or Nurse Anesthetists

Low Prevalence of Designated Lactation Spaces at Hospitals and Ambulatory Surgery Centers in Iowa: An Educational Tool for Graduates’ Job Selection

Alleviating stressfeeding in the emergency department: Elucidating the tensions induced by workplace lactation space issues

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