Experiences of breast feeding at work for physicians, residents and medical students: a scoping review

Abstract

Objective: To review and summarise the available literature regarding breastfeeding experiences of medical students, residents and physicians.

Eligibility criteria: Articles of any design, including non-peer reviewed data that examine the experiences of breast feeding of medical students, residents and staff physicians.

Information sources: Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily, Ovid EMBASE, Scopus and Web of Science.

Risk of bias: All peer-reviewed studies underwent risk-of-bias assessment using relevant tools, depending on the study design.

Included studies: We included 71 citations; 51 surveys, 3 narrative descriptions, 9 editorials or letters to the editor, and 3 reviews.

Synthesis of results: Included articles were heterogeneous with respect to their study design, target population and outcomes reported. Most articles had a high risk of bias. Only five articles reported the impact of an intervention.

Description of effect: Despite heterogeneity, the majority of articles described important barriers to breast feeding for physicians, residents and medical students. These barriers were similar across studies, and included inadequate and inaccessible space, time constraints and inflexible scheduling, and lack of colleague support. The consequences of these barriers included low milk supply and early discontinuation of breast feeding.

Strengths and limitations of evidence: Due to the observed heterogeneity of articles identified in this review, we are unable to assess trends in barriers or duration of breastfeeding over time.

Interpretation: Interventions to overcome systemic and cultural barriers to breast feeding are needed to meet legal obligations of workplaces for physicians and trainees. These interventions should be formally evaluated using implementation science or quality improvement methods.

Keywords: health policy; health services administration & management; medical education & training.

Figure 1

Flow diagram of included studies.

Figure 2

Rates of study participants that reported each breastfeeding outcome by individual study. Each study is represented by one circle, with the size of the circle is proportional to the number of participants in that study.

Figure 3

Duration of breast feeding reported by individual studies, stratified by faculty status of participants. Each study is represented by one circle, with the size of the circle is proportional to the number of participants in that study. (A) depicts studies that reported duration of breast feeding as a continuous variable and (B) depicts studies that reported duration of breast feeding as a categorical variable.

Figure 4

Barriers to breast feeding at work reported by individual studies. Each study is represented by one circle, with the size of the circle is proportional to the number of participants in that study.