One Pump at a Time: A Wearable Lactation Pump Pilot for Graduate Medical Education Trainees

Introduction

Human milk has many known benefits for both the lactating parent and for the infant. ¹ Exclusive breastfeeding is recommended for the first 6 months of life with inclusive breastfeeding (including breastfeeding as part of the child’s nutrition) for 2 years. ¹ As more trainees have children during graduate medical education (GME) training, it has become increasingly important to identify strategies for support upon return to work. ² Trainees are unlikely to be granted enough leave to fully establish a sustainable lactation routine, thus it is paramount that institutions create systems that support new parents in their lactation goals. ³ In June 2018, the Accreditation Council for Graduate Medical Education (ACGME) Common Program Requirements approved revisions to instruct residency and fellowship training sites to provide appropriate support for lactation, including proper space and time. ⁴ However, the most impactful ways to support lactating trainees remain unclear.

Previous studies have documented multiple difficulties that lactating residents encounter when returning to work and it is known that physicians are at increased risk for early unintended weaning.^5–8 Furthermore, one study found that lactating residents feel that pumping can be detrimental to their job. ⁵ A recent survey of lactating physicians who utilized wearable lactation pumps found benefits including shorter pumping breaks and increased likelihood of meeting lactation goals. ⁹ Wearable lactation pumps have been studied for GME trainees qualitatively ¹⁰ but not quantitatively.

The objective of this study was to examine the potential benefits of wearable lactation pumps to facilitate education and clinical care for GME trainees (residents and fellows) via a proof-of-concept pilot study.

Materials and Methods

This prospective pilot study was conducted at a large academic medical institution in the Midwest with 31 residency programs and 82 fellowship programs when accounting for both ACGME accredited and unaccredited programs. In 2022–2023, a convenience sample of all lactating GME trainees were eligible to participate in the study. Wearable pumps (Elvie Stride or Willow Go) were purchased by the study team with institutional sponsored grant funding. After approval by the Institutional Review Board, a study recruitment email was sent to all trainees in graduate medical education. Participants who enrolled in the study completed six baseline surveys (Table 1) over 2 weeks inquiring about their experiences with lactation including their number of completed and missed pumping sessions and the perceived impact of lactation on their medical education and clinical care, as well as their self-perceived level of burnout. Baseline surveys were completed while the participants were using a traditional (non-wearable) pump of their choice, and wearable pumps (Elvie Stride or Willow Go as selected by participant) were distributed after the baseline surveys were completed. The same six surveys were repeated over 2 weeks approximately 1 month after receiving the wearable pump. Participants were asked to use the wearable pump exclusively at work during the study period and to inform the study team if they did not use the wearable pump exclusively, so that they would be excluded from the analysis. Participants who did not complete both sets of surveys were excluded from the analysis. Analysis was completed using R version 4.3.3 and package lme4. Linear and logistic mixed effects models with a random intercept at the participant level and fixed effects for each of the 6 survey time points and phase (pre-/post-) were used to compare reported pumping experiences before and after receiving the wearable pump. Reported number of missed pumping sessions was dichotomized into participants who reported 0 missed pumping sessions, and those who reported missing any intended pumping sessions.

Results

Twelve lactating trainees participated in the study, with 10 participants completing all pre- and post-surveys. When compared with their experiences before using the wearable pump, there was a significant decrease in the perceived impact of lactation on clinical care (p = 0.03) and medical education (p = 0.004). There was a significant difference in the number of participants reporting missed pumping sessions (p = 0.02) with fewer missed when using wearable pump (Table 2). There was no significant difference in number of intended sessions or degree of burnout. Participants were invited to use the pumps for as long as their lactation journey continued. The mean duration of use of the wearable pump was 4.5 months with no participants discontinuing use within 1 month of the study. All participants who used the wearable pumps reported that it helped them to meet their lactation goals. Those who discontinued use of the pump all reported they had stopped lactating. The two participants who did not complete pre- and post-surveys decided to discontinue lactation and therefore stopped using all pumps. All participants reported using the wearable pump exclusively during the study period.

Discussion

The present study found that in a pilot group of lactating GME trainees, use of wearable lactation pumps resulted in a significant decrease in missed pumping sessions and perceived impact of lactation on clinical care and medical education. While the barriers facing lactating GME trainees remain, our study looks to explore the impact of innovative strategies of support through this pilot data. Additionally, our pilot data add to the robust body of literature documenting the struggles of lactating trainees and some recommended strategies for support that should be adopted both institutionally and nationally.^4,11–13 Building on previous work in the general physician work force ⁹ and early qualitative success of wearable pump introduction within residency programs, ¹⁰ this study represents a pioneering effort to quantify the benefits of wearable lactation pumps to facilitate lactation for residents and fellows, with a particular focus on the impact on educational engagement, the delivery of clinical care, burnout, and ability to adhere to planned pumping schedule. We found that trainees equipped with wearable pumps reported significantly fewer interruptions to clinical care and medical education. Furthermore, all participants who used the wearable pumps reported that it helped them to meet their lactation goals. This suggests that wearable pumps may play a pivotal role in harmonizing professional responsibilities with lactation needs. Of note, at baseline participants were “neutral” that pumping negatively affected their clinical care (2.67 ± 0.273) and medical education (3.05 ± 0.361), which improved to “disagreeing” (1.97 ± 0.209 and 2.10 ± 0.246) with these statements respectively after using the wearable pumps. This degree of change may positively affect outcomes like length of lactation duration, but a larger study would be needed to show true clinical meaningfulness of this finding.

These findings are consistent with previous research suggesting that lactating physicians who utilize wearable pumps experience benefits such as reduced pumping time and better fulfillment of lactation goals. ⁹ Early qualitative data from another institution also support these outcomes, with residents reporting enhancements in efficiency, satisfaction, supply, and duration of lactation. ¹⁰ Our investigation extends this knowledge base specifically to GME trainees, where the demands of training add additional challenges. Although the sample size lacked the power to detect differences in adherence to planned pumping schedules, all participants felt wearable pumps helped them reach their lactation goals. Purchase price of the wearable pumps in the study was approximately $250–$300. While insurance coverage varies nationally, the most common insurance plan at the study institution does not cover wearable pumps, which may make these devices cost-prohibitive on a trainee salary, especially considering additional costs of a newborn and childcare.

The study’s strengths include its novel focus on the impact of wearable lactation pumps during GME and its direct and real-time assessment of their influence on educational and clinical responsibilities. Limitations include the reliance on convenience sampling, self-reported data which could be impacted by the Hawthorne effect, a modest sample size, and the confinement to a single institution, which may affect the generalizability of our findings. Furthermore, it is feasible that responses were biased due to the incentive of receiving free pumps. Nonetheless, these preliminary results advocate for GME programs to consider the implementation of wearable pump technology as a strategic measure to support lactating trainees. It is important to note that lactation pumps of all kinds have variable efficacy for lactating individuals, and supporting wearable pumps does not negate the need for comprehensive programmatic and institutional lactation policies.

Conclusions

In conclusion, wearable lactation pumps show potential to mitigate the perceived negative impact of pumping on medical training. While the relationship between wearable pump use and burnout or pumping session adherence remains to be elucidated, this study is an essential step toward identifying feasible and effective support systems for lactating residents and fellows. Larger, multi-center studies are warranted to explore the long-term implications on lactation duration and to establish evidence-based policies for fostering a supportive training environment for lactating medical professionals.