The Bad Breast: Issues surrounding Lactation and Return-to-Work for the CL Psychiatrist

Abstract: The World Health Organization recently updated its recommendations to a goal of 2 years of lactation, including breastfeeding, chestfeeding and pumping. Many new parents, especially physicians, set lactation goals of 6-12 months to maximize health benefits to their baby and themselves. Female physicians have higher risks of infertility, subfertility, and pregnancy complications than their peers. Early research shows that physicians are often unsupported in reaching their lactation goals. Though psychiatrists presumably enjoy a higher quality of life than other specialties, psychiatry has its own unique barriers to lactation, informed by cultural factors and psychodynamic conceptualizations of reproductive organs.

In this workshop, we will explore data supporting benefits of human milk, barriers to achieving lactation goals for physicians, and how these issues are uniquely manifested for CL psychiatrists. Finally, we will explore how these themes apply to psychiatrists facing intersectional disparities such as those who are themselves racially, ethnically, gender, or sexually marginalized. We will consider the impact on physician wellness, workforce health, and the ways in which our lived experiences potentially impact the advice we give patients.

0:-00-0:15 Dr. Beth Leimbach will review the evolving global recommendations regarding lactation, benefits of human milk to babies and mothers, costs of breastfeeding, limitations of the current evidence base, and realistic decision points for working lactating parents. She will give examples of CL consults relating to lactation, such as psychiatric medications penetrating into milk, and psychological benefits of lactating or utilizing other feeding options.

0:15-0:30 Dr. Adrienne Mishkin will focus on how lactation intersects with gender inequity for female physicians. She will contextualize this within the many burdens on physician mothers through family planning, pregnancy, delivery and returning to work. She will focus on fourth trimester concerns such as parental leave, return to work policies, lactation facilities, time, schedule flexibility, and hostile working environments. She will review the evidence for compounding racial and ethnic inequities related to these policies. She will include how these issues have been addressed at medical conferences. She will comment on implications for clinical practice and professional growth among CL physicians.

0:30-0:45 Dr. Paula Askalsky will discuss historical ideas about the psychodynamic meaning of breasts in psychiatry and how these concepts differ from our perception of male sex organs. She will explore the ways in which the cultures of medicine and psychiatry interact to create unique challenges to maintaining lactation in CL psychiatrists, including barriers to self-advocacy for appropriate accommodations despite legal protections.

0:45-0:60 Dr. Lisa Linde will discuss considerations for gender and sexual minoritized and marginalized people who are lactating, including lactation induction for a non-gestational parent, the effects of gender-affirming hormonal and surgical treatments on lactation, medical and societal barriers to lactation, and how these issues may affect physicians and CL psychiatrists who identify as LGBTQIA+, as well as those working with these populations clinically.

1:00-1:15 The audience will be invited to share and discuss their perspectives on these themes.