How To Build A Breastfeeding Policy At Your Residency Program

Residency was never designed with lactating physicians in mind–nor should it be. We're certainly the minority. As medical education and training evolve, it's time to make breastfeeding "okay" for residents. 

For decades, breastfeeding in training has depended on individual luck: the right attending, the right rotation, the right chief who happens to get it. But luck is not a policy, and it certainly isn’t a support system.

When I had a baby in residency, I realized quickly that the barriers weren’t personal; they were structural. 

There was no departmental written policy. 

No protected pumping time. 

No standardized location. 

No guidance from senior residents, program directors, or attendings. 

The expectation was simply: “figure it out.” And like so many resident-parents before me, I did. But it was unacceptable that the burden fell on the resident every single time.

So I built a policy instead.

Here are some considerations as you approach your department and suggest the implementation of a breastfeeding policy.

Step 1: Start by naming the problem out loud.

Most programs think they’re “supportive” because a few faculty members have been informally accommodating. But informal support is fragile. It evaporates with rotation changes, personality conflicts, staffing constraints, or a single unsympathetic attending.

The first step is saying the quiet part out loud:
Without a formal policy, breastfeeding residents are functionally unsupported.

Once that truth is stated clearly in writing, the conversation can move from “accommodation” to infrastructure.

Step 2: Gather the standards that already exist.

One of the most effective ways to build institutional buy-in is to show that the institution is already supposed to be doing this.

Bring the receipts:

• ACGME Institutional Requirements now mandate lactation facilities and adequate time for lactation.
• Federal law (PUMP Act) protects break time and space for pumping.
• Most major medical centers have system-wide lactation guidelines—they simply haven’t been tailored to residency workflows.

Presenting these sets the baseline:
This is not a favor. This is compliance.

Step 3: Identify the logistical pain points and solve for them directly.

Every program has a different clinical rhythm. The policy must fit the workflow rather than disrupt it.

Questions to answer:

• Where exactly will residents pump?
  (Private, lockable room; not a bathroom; ideally close to clinical areas.)
• Who covers pages/phones during pumping?
  (Distribute across team; chiefs can create standardized coverage in daily assignments.)
• How often and for how long?
  (Usually 2–3 times per shift; 15–20 minutes; must include travel/setup time.)
• What happens on high-acuity rotations?
  (Pre-identified coverage plan; attending awareness; adjusted expectations.)

When I wrote our policy, I included specific, operational language, not vague statements. The more concrete the logistics, the easier it becomes for chiefs and attendings to implement without friction.

Step 4: Build it with allies, not in isolation.

This is one of the most important parts.

I partnered with:

• A supportive program director,
• GME representatives familiar with federal requirements,
• Other resident-parents who had navigated this terrain alone.

Policy building becomes much easier when it’s framed as fulfilling institutional obligations and improving resident well-being, not as a personal request from one trainee.

Step 5: Create a written document that leaves no room for interpretation.

A breastfeeding policy should include:

1. Guaranteed access to a lactation room (or realistically, just a secluded, lockable room).
2. Protected break times and how often they occur.
3. Coverage expectations for the resident’s clinical duties.
4. Instructions for chiefs on scheduling and backup plans.
5. A statement of non-retaliation for lactation needs.
6. A clear escalation pathway if the policy is not honored.
7. Flexibility for night shifts, OR days, and ICU rotations.

This turns support from something optional into something standardized, consistent, and enforceable.

Step 6: Normalize it. Publicly.

A policy only works if it’s culturally accepted.

When ours was finalized, I made sure:

• It was included in the resident handbook.
• It was discussed at orientation.
• Chiefs were briefed on expectations at the start of the year.
• Faculty were reminded at division meetings.

Visibility protects residents. Silence isolates them.

Step 7: Measure the impact.

New policies should be followed by real outcomes:

• Residents reporting less stress or guilt about pumping.
• Fewer conflicts with attendings.
• Protecting milk supply without sacrificing clinical performance.
• Improved parental leave experiences overall.

When programs track these changes, continued investment becomes obvious and expandable.

Breastfeeding support should never rely on heroics.

No resident should be stitching together their lactation plan in the shadows of a call room or begging for coverage between cases. Residency is hard enough; breastfeeding shouldn’t require negotiations, apologies, or secrecy.

Policies create protection.
Policies create predictability.
Policies create the culture residents deserve.

And the programs that implement them are the ones building a future where being a parent and being a physician are not competing identities, just part of a fully human training experience.

‍