Why Physician Moms Are Leaving Medicine with Dr. Alia Hussain

Apr 2

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🎙 Episodes 7 & 7.2 | Endocrine Matters Podcast

Motherhood and medicine shouldn’t be mutually exclusive, but for too many women physicians, that’s exactly how it feels. In this powerful episode, Dr. Arti Thangudu sits down with Dr. Alia Hussain, a direct care pediatrician and lactation advocate, to explore why physician moms are leaving medicine—and what can be done to stop the exodus.

Together, they unpack the real barriers facing new mothers in healthcare: from inadequate maternity leave and lack of breastfeeding support, to the impossible pressure to “do it all” without structural accommodations. Dr. Hussain, who makes house calls for newborns and works closely with lactation consultants, offers a model of care and compassion that reimagines what’s possible when we support moms in medicine.

This is a powerful conversation for anyone working to create a medical system that values both caregivers and the care they provide.

Listen to the Full Episode

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Key Topics & Timestamps

Skip to specific parts of the episode:

04:46 – Importance of Breastfeeding
07:31 – Breastfeeding Challenges and Solutions
20:46 – Support for Breastfeeding Moms
27:47 – Training and Education in Breastfeeding Medicine
35:07 – Challenges of Pumping at Work
37:39 – The Impact of Workplace Support
38:39 – Physician Retention and Motherhood
41:16 – Advocating for Breastfeeding Rights
43:49 – The Need for Maternity Leave and Daycare
55:59 – The Motherhood Penalty

Episode Highlights

Key Takeaways:

Breastfeeding in Medicine: Why it’s so difficult for physician moms to sustain breastfeeding—and why it matters.
The Culture Shift We Need: Creating environments where women aren’t forced to choose between career and family.
Breastfeeding as Preventive Medicine: The science-backed benefits for mom, baby, and society—and why it deserves more institutional support.
The Physician Retention Crisis: 25% of women doctors leave medicine or go part-time within 6 years of training. It’s not personal failure—it’s system failure.
Real Solutions: From meaningful maternity leave and better pumping accommodations to hospital-based childcare, we explore what’s possible when we prioritize physician well-being.

Alia: [00:00:00] It is a cultural change. I think in the workplace and in, you know, the hospital setting in our training programs for for new moms position, new moms. Um, it is a shift in culture that that needs to take place that, um, we need to normalize breastfeeding, that this is something that That happens, that this is part of the world, it's a normal thing, and um, just to, to give those new moms a little bit of support and flexibility.
As a society, as we're changing into a more healthier, preventive society, we're focusing on preventive health, part of that is breastfeeding, and um, and I hope that that is given, um, the importance that it deserves.
Arti: I am absolutely thrilled to have Dr. Alia Hussain, a phenomenal pediatrician and an incredible human being on the show today. Dr. Hussain is a direct care pediatrician and [00:01:00] I trust her with my own two precious children. Her kindness, thoroughness, and genuine love for her little patients, their parents, and her field shine through in everything she does.
She is also a bold and unwavering advocate for breastfeeding when it's the right choice for both mom and baby, and I am here for it. Dr. Hussain goes above and beyond for her newborn patients by seeing them in the comfort and safety of their homes, where moms and babies can thrive. She provides invaluable support for breastfeeding and new motherhood during those delicate early days that are so vital for building a healthy breastfeeding relationship.
As a mom who has experienced this journey firsthand, this conversation nearly brought me to tears. I vividly remember those early days of motherhood. The uncertainty, the fear, the preciousness, and the overwhelming sense of responsibility that comes with nourishing a tiny human entirely with your own body.
We know that breastfeeding offers profound health benefits for both baby and mom with [00:02:00] long term impacts on physical and emotional health that ripple through entire communities and even the economy. Yet, despite living in a world obsessed with longevity medicine, nutrition, and preventative health gadgets, we lag woefully behind in supporting this natural, free, and basic right that every mom and baby should have access to.
The lack of support comes in many forms. Cultural stigma around breastfeeding, inadequate maternity leave, and inflexible work environments for moms returning after giving birth. These challenges are especially acute in healthcare, where a primarily female workforce, including physicians, nurses, and other clinical staff, faces unique hurdles.
A startling statistic reveals that 25 percent of women physicians leave practice or go part time within six years of finishing training. This should alarm us all, especially given the physician shortage we're already grappling with. For many of these women, the decision isn't about a lack of love for their work or their [00:03:00] patients.
It's because they're forced to choose between their careers and their families, a choice no mother should have to make. I've been there myself. Six years ago, as my little guy struggled to thrive due to my unrelenting work schedule, I was on the verge of stepping away from medicine. The only reason I'm still here is because I found an alternative practice model that allowed me to prioritize both my family and my career.
For too long, society has framed women's decisions to leave the workforce as a personal weakness. But the truth is, this isn't a flaw in women, it's a flaw in our work environments, and it's fixable. Women have arisen to every challenge. We've had babies, driven scientific advancements, improved patient outcomes, and contributed financially to our families, all while shouldering more than 80 percent of child related responsibilities.
And yet, too many women physicians find the demands of the profession Incompatible with their growing families. If we don't fix this, there may come a day when there's no compassionate doctor [00:04:00] to care for us when we're sick. In this episode, Dr. Hussain and I discuss how supportive maternity policies, including meaningful maternity leave and breastfeeding accommodations, can keep women, especially women physicians, thriving in the workforce.
These are women who have trained hard, who are capable and who bring immense value to their patients and their communities. It's time to stop asking women to choose between their careers and their families. This conversation was one I truly loved and I hope you will too. If you're looking for links to anything we discussed, be sure to check out the show notes.
Hi everyone. Today I have Alia Hussain, who is the best pediatrician. Ever. I can say this from experience because I trust her to take care of my two littles and we are talking about something that is so important and under discussed and it is breastfeeding and you might be wondering, [00:05:00] why are we talking about breastfeeding on a health systems podcast?
Well, what many people don't know is now most medical school graduates are women. Um, 54 percent of medical school graduates are women and. In our field, in my field, endocrinology, 70 percent of endocrinology fellows are women and pediatrics too. I don't know the statistic, but pediatrics is female dominated as well.
And so this is a very important piece of the puzzle for supporting and keeping women doctors in the clinical space as well as. A way that we can connect and support our patients going through a very fragile, important time of their life. And so, here Alia is. She's not only a pediatrician, but she's an expert in lactation and takes care of newborns.
And I'm just thrilled to be having this conversation with her today. So, [00:06:00] Alia, welcome!
Alia: Thank you so much, Artie. Um, thank you so much for having me and I look forward to discussing breastfeeding and motherhood and the challenges that come with all of that, um, especially for women in medicine. Um, as they, you know, there are, they're in that age bracket as well when women are having babies during that time when they're training in, uh, residency.
Um, so it's a challenging, challenging time. I just wanted to introduce myself. Um, I'm Ali Hossain, as Arti said. I'm a board certified pediatrician. I've been in practice for 13, 14 years, so I've been doing this a while. Um, I also have three kids of my own, and my son, eldest son, was born during my residency time.
So, I've been through it. I've been through the trenches with, um, you know, all of the breastfeeding challenges that come along, um, with, you know, trying to, um, you know, star breastfeeding during residency. Um, [00:07:00] and now I have a DPC or direct care practice that basically has a one component of it is that I do house calls for newborns, uh, in the first few months of their life.
And so I get to see moms, new moms, you know, experienced moms, um, in their in their homes. Um, you know, starting that breastfeeding journey the minute they get home from the hospital. Um, and I work closely with a lot of lactation consultants, uh, to support them and to help them through that journey and to get that started.
Arti: This is such an incredible service. And I think any mom who has been in that space, unfortunately, I I did not have Alia when I was breastfeeding my two kiddos, and my first one was born when I was a fellow, too, and having a baby is hard, and being a fellow is hard, and those two things, being a medical trainee, I should say, is hard, and having those two things at the same time.
Certainly poses a special type of challenge. Um, and I think that before [00:08:00] you have a baby, you have no idea what you're getting yourself into. You have no idea what it's like to be the, another human soul source of nutrition and the immense responsibility that comes with motherhood that we, thankfully, Are are naturally sort of gifted with when we when we have our babies, but first, Ali, I'm so grateful that you started by telling us a little bit about yourself.
But tell me what drew you to your career and what has kind of gotten you to this this particular space because it is a very unique and special space.
Alia: My career started, you know, just as a traditional pediatrician. I went through residency training and joined, you know, a group practice where, um, I was seeing, you know, 30, 20, 30 to 40 patients a day, spending a few minutes, um, you know, with each patient.
Patient as most traditional insurance based practices are they are very [00:09:00] busy and you you see your pediatrician in and out in and out Not a lot of time for new moms to ask questions definitely not enough time for the pediatrician to sit down and observe Um, you know, how she's breastfeeding, how she's holding the baby, does the baby have a good latch?
Um, you know, is the baby getting enough? Um, all of that. So I went through many years of, you know, kind of doing the insurance based traditional practices. And then during the pandemic, um, I started my own direct care DPC practice. And I wanted to offer something that was unique and Um, that I felt there was a gap in what the pediatric care out there didn't have, um, which was the house calls for newborns.
And so I do provide, and in the first couple of months I go out and, you know, as soon as they're home from, discharged from the hospital or birthing center, I go out and see baby and mom and I spend at least an hour in their home watching mom feed. We [00:10:00] do a pre and post feeding, um, Wait to see how much baby has transferred looking at Lodge teaching, um, about.
different positions, you know, different things and tricks that, that can work. Um, and so I felt that there definitely was a gap in what moms were getting from their pediatricians in terms of breastfeeding and lactation education. Um, and education for lactation and breastfeeding starts in the hospital, right?
Like when you have a baby, um, you sometimes, usually lactation consultant to come in and kind of educate them a little bit, you know. 15 20 minutes here and there. Um, but then that's it and then you go home and you're kind of like, okay, now I have this baby and I don't know what, what to do. Um, and it's it's stressful and it's scary and um, so that's kind of where, where I come in and I um, you know, my patients can text or call me if they have questions and they, you know, especially new, new parents do have a lot of questions, which is great.
Um, but I prefer them to call and reach out to me if there's anything [00:11:00] and so I work closely with Good group of, um, lactation consultants as well. And I also, uh, help moms kind of, you know, start with that education and, and just teaching them handholding a lot in those beginning. Beginning few months.
Arti: I think this is a beautiful example of, um, recognizing what we can do as as physicians and humans and supporting other people to better health and better.
experiences and recognizing that in the system that is prescribed to us with the traditional insurance system, like we cannot give our best in that setting. And I love how you kind of took the reins and said, look, I can do better, but I'm not able to in this system that doesn't support me to be the best physician that I can be.
So let me try something different. [00:12:00] And Alia, can you tell us, like, what kind of things were you seeing in that traditional setup where patients aren't getting that support in the beginning. What kind of outcomes or problems were you seeing?
Alia: So, just to give you a little statistic, about maybe 80 to 90 percent of moms start off, uh, breastfeeding their kids and their infants in the hospital.
But, maybe anywhere, the statistics show anywhere from 20 to 25 percent of moms actually continue to breastfeed in the first six months. So, where, You know, that big gap, a lot of moms kind of quit in the first couple of days, weeks, months, um, because there are so many hurdles and so many struggles that come with breastfeeding.
And it's not easy, you know, breastfeeding is a hard full time job for mom initially. It doesn't come naturally for everybody. Um, it is supposed to be a natural process. We think, you know, um, all moms should breastfeed, all babies should [00:13:00] be able to be born learning, you know, they should know, already know how to latch, but that's not the case.
You know, there are a lot of babies that have struggle with tone issues. They have, um, you know, latch issues, uh, obviously anatomically, if a baby has any sort of palate or, you know, uh, sometimes, uh, rarely tongue ties or other, you know, sort of Structural problems. Um moms can have inverted nipples. They can have low low production, um, stress can play a big role in it.
So if you know there's not a lot of support from mom where she isn't being sort of properly taken care of and if she doesn't have a good support system in place. Um of course that stress can play a role in milk production and and breastfeeding can then sort of Be, um, not as, uh, fruitful and can become a source of sort of, uh, stress and anxiety for mom as well.
Um, so, you know, like I said, the traditional office set up for pediatrician is [00:14:00] Uh, back to back appointments, a lot of the education is done by the, um, medical assistants or the nursing staff. Um, so the doctor doesn't really spend a whole lot of time, you know, sitting with mom and talking about breastfeeding.
Um, in, in the traditional office. So, the way my practice is set up, I, I have that luxury and I, you know, I really do. Even pre, prenatally, we have a prenatal visit. Moms come in, they talk about certain things that they, you know, may have questions about, concerns about. Talk a little bit about what to expect and then a lot of the breastfeeding support comes from actually sitting and Sitting with baby and mom helping her latch showing her different techniques getting a lactation consultant involved if we need to And just a lot of education, you know, I have some, um, you know, pictures that I show them, some little models and things to, to show them, um, just making sure that they have all those tools to help them have a, um, a supportive and fruitful breastfeeding journey.[00:15:00]
Yes,
Arti: I think that. We assume that like biologically we're supposed to do this so it's going to be easy and then you go through it and you're like Holy smokes. This is not easy. I actually Thankfully was able to breastfeed both of mine for 12 months exclusively, but I don't think I would have gotten through it Had my husband not been so involved like when after I delivered my baby or my my older one I was so tired.
I was so out of it. I couldn't comprehend what they were telling me. And my husband, like, really, like, he, he kind of stepped up and really worked with them and took his own notes and, like, I, I tell people, like, my husband taught me how to breastfeed, but it is It's not always natural. It wasn't in my case and we ended up having a successful relationship in that way But it was [00:16:00] hard and it's painful and people can't it really feels like you're doing it wrong in the beginning And so I think that this type of support would enable many more mothers who want to To breastfeed if they had this sort of like, I wish I had prenatal coaching like, you know, to help me understand what I should expect to come.
But I think we've talked a lot about the challenges of breastfeeding. And I think it's important to go into like, why are we even doing this? Why is it important? Is it should we be so invested in this? And I think I know the answer, but I would love to hear kind of your thoughts on. On why breastfeeding is important.
Alia: So there's, I kind of break it up into three pros, like three lists of, um, pros of breastfeeding. One, of course, is the obvious, um, benefits to the baby. Nutritionally, breast milk is [00:17:00] made by the mother's body for that baby, particularly. Um, and it, breast milk, the components of breast milk, the, the makeup of the breast milk changes.
You know, with the baby's age, with the time of day, um, with, you know, obviously what mom consumes, um, and it's really It's, it's miraculous to me. I think I call it liquid gold because, honestly, it's, it's like food for a baby that's actually specifically made for that specific baby, for that specific baby's age.
And so, um, there's numerous, you know, benefits to breastfeeding. Obviously, the nutritional component, um, It is, you know, full of, you know, nutrients. It's full of antibodies. So it protects babies from infections, um, there, uh, you know, it's at the right temperature. You don't have to warm, you know, if, if you're latching, you don't have to warm up a bottle.
Um, so there's obviously numerous health benefits to baby, um, in terms of, [00:18:00] Immunity and nutrition, and even, um, research has shown that cognitive testing in babies who are breastfed versus formula fed, they actually, um, you know, perform better on cognitive IQ testing and things like that. Not to say, you know, formula fed babies, of course, are not.
Okay. They're getting the right nutrition as well, but there's a little bit extra sort of, uh, benefit to, um, breastfed, you know, babies and getting that breast, breast milk. Um, and then, of course, to mom, uh, the benefits of, uh, there's a decreased risk of, I'm sure, um, you've, you've read this research as well, decreasing breast cancer, ovarian cancer, the bonding component, obviously the emotional attachment of latching.
Um, not that, not to say that formula fed babies cannot have that bond as well being held and, and, and bottle fed and then the financial component of it, right? You're not having to buy hundreds or thousands of dollars worth of formula for your baby when you have a natural source, um, of food right there, like with mom.
So, um, [00:19:00] those are probably the big ones. I don't know if there's anything else you want to add to that. No,
Arti: I think those were great. I think that there in no way do we ever want to shame a mother who is unwise. Unable to breastfeed her child or chooses not to for other reasons, I think there are plenty of ways to have healthy, happy babies and breastfeeding is not the only solution for every single person, but I think there is strong data to show that if we are able to, this is the one thing that We can do for our Children and ourselves.
That is that benefits all of us. And, um, I think that we can't Underestimate that knowledge, like if you are to tell people pay thousands and thousands of dollars to have these screening tests, these early screening tests for cancers and that don't have any outcomes, [00:20:00] any positive outcomes linked to them, you know, but here we have this thing that's free that can decrease mom's risk of breast and ovarian cancer, which, of course, nobody wants to have and can improve your Babies and child's lifelong health, and we're so health obsessed, you know, we're so focused on investing in our health, which is great, but some of the things are basic things like this that we can, um, engage in so long as we have the, the right support.
The sad part, though, is oftentimes we don't have the right support. So I would love to hear your thoughts on. How, you know, particularly, a lot of listeners of this podcast will be women in medicine. What particular challenges do you think mothers [00:21:00] have when they are working moms or physician moms?
Alia: Um, being a physician mom, I think comes with extra challenges.
Um, you know, as we all know, you know, our time is limited. We're busy. Um, the kind of work that physicians do, you don't really have a lot of downtime. Um, and, and the work is stressful, right? Your, uh, your mind is engaged in ways you have a lot of decision making. Um, so, you know, I think being a physician and breastfeeding at the same time, obviously it comes with a lot of challenges.
Especially for those physician moms that are in training and don't really have a lot of, um, control over their schedules, I think, and, and the situations that they're in. Um, of course, when you're in training, you're in, uh, in the hospital, you might be in an ICU setting, you could be, you know, an emergency room, um, running codes, uh, in surgeries for long periods of time.
And, Um, when you're breastfeeding and you have to pump at work, obviously you have to do it in a specific amount [00:22:00] of time so that your body doesn't kind of give that negative feedback that, hey, I don't need to produce this amount of milk. And that's where those supply issues come in with breastfeeding.
So I think some of the challenges that come with, especially for, for physician moms are, you know, finding that time, especially. You know, if you're in long rounds or, you know, just taking those breaks every two to three, four hours to breast, uh, to go and pump and then not having those safe spaces or private spaces to go and pump as well.
Um, that was a challenge for me, um, during residency. I remember, of course, rounds were very long. There were, and I was in a pediatric, uh, residency. So you can imagine, you know, we're very baby centered and I was in the NICU where there were actual. Um, you know, mom's pumping and breastfeeding there, um, but still, even with that, um, you know, just finding that space and the resident room was shared, um, there could be people knocking at the door and calling you or paging you for emergencies and things like that.
So obviously those are challenging. And [00:23:00] then especially for those moms who are in those, um, those medical fields that are procedural based or if you're in the O. R. for long periods of time and you don't get those breaks. Um, I've had, uh, friends, physician friends who have done, you know, like wearable pumps where they've put the pumps on and, you know, gone into clinic and again, not the greatest experience Um, pumps in the sense that yes, they exist, but they don't have the best section.
They sometimes, you know, they're, they're okay. Um, but that shouldn't be the case. Like, I think physician moms should have the ability and, and be given a little bit of, um, you know, that preference that, Hey, it's time for me to go pump. 20 minutes. I'm going to go pump and I'll be back and I'll get back to work.
And, um, you know, obviously their productivity would probably be better at work and just being able to, um, You know, go and pump and come back and be able to take care of their patients. Um, but definitely being a physician mom comes with its unique challenges. Long [00:24:00] hours, night calls, um, 24 hour calls, when, when back in the day when, when those existed when I was in training.
Um, not the easiest being away from your baby for that long, you know. Um, and so, um, I hope that with the future comes changes that are beneficial to physician moms and, and, and we move in that direction. Just recognizing. Um, that physician moms, uh, need that support and, and the tools, uh, to have assistance.
And
Arti: the grace, right? I think being given some grace or not, I think. In medicine, even though more women are going into medicine than men now, it's still a male dominated field. And I think a lot of women feel like we have to work like men, actually work harder than men to get the credit, equal credit, or at least some credit.
And I think a lot of women, not just physicians, but women in high powered [00:25:00] fields or, um, Fields that require a lot of investment, like, like medicine, feel like they have to, you know, do the same thing as men running backwards in high heels. And like, with, with breastfeeding, it's almost like you are made to feel or you just do feel intrinsically that you are taking something away and you should only be.
Where you should only be giving yourself and your time and, and I think that is something that is a whole mindset shift that, that I think we are working towards. Um, but I do think it is a, a huge challenge, but you touched on something that I think is actually really important. And. It's the one pumping, but to the importance of time spent with your baby.
And I'm going to tell you a story that happened to me from a friend of [00:26:00] mine that actually Is a pediatrician was I think I think yeah, she was already done with her pediatric residency at that time And we were talking about a trip a Bachelorette party to actually and I was and my daughter was gonna be about four four months old at that time and I was trying to I was trying to figure out how I could bring her with me because, you know, she was exclusively breastfeeding, and it's very difficult to exclusively pump for several days without your baby because your breast milk production goes down, and This person was opposed to me doing that and and they were like, well, you could just pump everybody just pumps and it was somebody who didn't have a baby.
And of course, I was pumping at work already, but it was also a pediatrician. And so So, to me, I was [00:27:00] like, I was very hurt by it and upset and clearly this person didn't understand what breastfeeding was, even though they were a pediatrician. So I'd love to kind of hear what your thoughts are on the under, the real understanding of what this is like for moms.
And at that point, I actually made a note in my head that I will never have a pediatrician for my children who's also not a mother, because. I just didn't feel like they could understand or at least apparent, but yeah, I would love to kind of hear your thoughts on that, that story, but more in the regards of like, how are, how are pediatricians trained around lactation?
And is that helping or hurting us as a community and supporting our patients?
Alia: So, going back to, you know, when I trained, um, we did have, we were lucky enough where we did have some, uh, residency training with lactation consultants, um, following them and learning [00:28:00] from them, um, there were some rotations that included some of that, which was great, you know, I think that was my basic, initially, this was prior to me, Um, I think I did that rotation when I was pregnant with my first one, so it was helpful to me, you know, as a physician, as a pediatrician, as well as, you know, as a mom, so I learned a little bit from them.
It was short, brief, you know, very basic breast breastfeeding medicine, um, slash lactation rotation, you know, kind of rotation in residency. Um, so a lot of pediatric residencies don't even have that. It's not, I think more of it, more breastfeeding medicine has been integrated over the last Uh, probably 5 to 10 years, which is great.
I'm I'm all for that. Um, and then some pediatricians have gone on and I have quite a few, um, pediatrician friends who have gone on to get their IBCLC, which is, uh, they are certified lactation consultants as well. Um, and then there's also a, I think, um, certification in breastfeeding medicine that some people are doing.
So [00:29:00] there is more awareness around the formal education and what benefits that can have for their patients. Um, and the majority of these pediatricians are getting these trainings not, you know, um, sort of, uh, increase their revenue or anything like that. It's really just for educating ourselves and educating our patients and having that knowledge that we can bring to them.
Um, so I think there is definitely a growing trend with, you know, lactation. I do understand, I get, you know, if you have a pediatrician that is not a parent. Um, I think there are some great male pediatricians out there that are parents, um, that have seen, you know, their, maybe their spouse's breastfeeding journey and, um, have learned from that, um, but, and I do have some pediatrician friends that are not parents that are great pediatricians as well.
So I think it just depends on the individual, um, doctor, and I think how You know, they feel as far as like supporting their, [00:30:00] um, their parents and the moms who are breastfeeding and, and what, you know, what kind of education they have themselves and what interest they've taken in this, in this specific, you know, have they, have they sort of gotten a little bit more training in breastfeeding and how to help and, and ways to help their patients and, and moms.
And some pediatricians really, they, They don't think it's their job. You know, they're like, well, it's beyond my scope of knowledge and you know, here's the number for a lactation consultant and I hope you can find somebody that can help you and that's, you know, that's fair. I mean, um, like I said, in some of these practices, you know, you're seeing a lot of patients.
You don't have time to sit down with each parent. Um, but really the thing with breastfeeding is if it's not established well, it's not successful. For a long, you know, for that, um, first year or whatnot. Um, It's really those first few weeks, days, and weeks that are so fragile and sensitive. And, um, if, if there's too many challenges to breastfeeding, moms do, you know, sort of give up and then it [00:31:00] doesn't continue.
Um, And the recommendation really is to breastfeed your baby for the first 12 months. And then AAP came out with a new one. I think, um, if I'm not mistaken, two years. Um, which a lot of parents, you know, a lot of moms don't breastfeed for two years, but, you know, so it's really that initial phase where if it's not, parents are not, moms are not educated properly, they're not supported properly, then they quit.
And, uh, unfortunately, you know, finding the right doctor is very important, I think, um. Especially for new moms who have never done it before or moms who have didn't breastfeed the first time around and have a second or third child and they they decide that, hey, maybe I want to give this a try and maybe we can be successful this time around.
Arti: Yeah, I think, I think, um, it is those first few weeks are so critical. Um, would you mind giving us so pumpkin always like I think for moms who have pump, it's always like a little bit PTSD and, um, Just, [00:32:00] nobody wants to revisit the sort of like, it's not gory, but people kind of feel like it's the gory details of, of pumping.
But, when a mom is Pumping for her baby. Will you tell us, like, how long does that take? And how often should she be doing it? Because I think this is something that's completely underestimated. Like, people are like, oh yeah, you can pump once at work. Or, like, pump in the car or something like that. And it's not that simple.
And if you don't, explain to us, like, what will happen.
Alia: So, pumping, your pumping schedule, if you're exclusively pumping and not latching your baby. During the day, for example, like if you're back at work, um, a mom should be pumping, you know, kind of on the same schedule as she would be feeding her baby. So most newborns, um, well, if you're going back to work, it's probably been at least six weeks, hopefully before you go back to work.
Um, but most [00:33:00] babies in that first one to two months, three months of age, they're eating their breastfeeding every, probably anywhere from two and a half to four hours. Um, and so if you're not pumping every, Three to four hours or sooner than that. Um, you know, obviously your, um, there's going to be a negative feedback loop and you're not going to produce that breast milk.
So that production is going to go down. Um, if you're going 6 to 8 hours in between pumping sessions. Um, that milk supply is going, your body's going to stop producing as much milk. Um, some moms like to pump even when they're home and during maternity leave, um, because it does stimulate more, more milk production.
So sometimes what we do is we, we, we recommend triple feeds, which is basically latching the baby, letting baby feed, um, and then pumping after and then feeding the baby that pumped milk. And that's really for those moms that are not producing enough. Enough milk and just to kind of stimulate supply, um, sometimes that can end up [00:34:00] causing, you know, overproduction, but only in certain situations.
Do we do that? Um, and some moms, even during their maternity leave, start to, um, store some of that breast milk. You know, freeze it, use it for, for later, um, or store it for sixth season, you know, um, later on because it has, you know, antibodies and things like that. So, really, it's different for each mom, but the, the stigma kind of around pumping and, and the, I get it.
It's not the, the most fun activity. You have to sit there with your pump on and, you know, it takes time. Sometimes uncomfortable, um, the one thing I do with, with my moms is that I, um, during the first couple of, I don't really recommend pumping in the first two weeks just because they're establishing that, um, that latch and everything.
And plus it becomes a little stressful that, hey, now I have to. Kind of do pumping and on top of all the all the the latching and the breastfeeding But after two three weeks, you know Mom's kind of get the hang of it and and we look at I sit with them We take the pump out of the box. [00:35:00] We look at the phalange size I go through all the little equipment and and show them, you know, like this is you know how to use it Have you watched a video?
Sometimes it's just the, the, the, the fear of, you know, the unknown, like, hey, this thing looks, has all these pipes and things, and I don't like it, and, you know, um, so I think just education in general and just removing that stigma with pumping, um, and the right pump for, you know, every pump is different too, but like, like you mentioned, if you're not pumping kind of every three to four hours, even at work, um, most, most moms when they do go back to work, they, they try to stay on that, that schedule.
But sometimes work gets in the way. There's just too many obstacles. You, you can't, you can't keep up and, um, that's where the milk supply comes down and, and, and it decreases and kind of, um, the breastfeeding journey kind of stops at that point.
Arti: And on average, do you know, like, is there an average number of how many minutes it takes to [00:36:00] like one pumping episode, how much time
Alia: it should take?
I think usually on average, it's probably somewhere from like 15 to 30 minutes. So, you know, setting up. Pumping, you know, 15, 20 minutes, washing your pump parts, putting everything back, you know, putting your milk in the fridge or ice, but you know, your little thing. So the whole process probably takes close to most people take about like almost half an hour to pump.
Um, sometimes a lot of workplaces don't have that allowance for, for even those 30 minutes. So, um, you know, moms end up pumping during lunch or lunch break if you're in an office setting. Um, if you have that option, um, but that's not enough, like if you get into work at eight o'clock and you're pumping at like twelve, one o'clock, and then you're not going home till five, driving home, you're not home till six, it's a really long stretch in between where you haven't had that pump, um, and so, you know, I, I find that I think a lot of moms do have that [00:37:00] challenge where, um, the time and just being away from work or away from their desk.
Arti: Yeah, I think that's one of the things that's very much underestimated in the workplace, especially in like a clinical setting or an outpatient setting where your patients are scheduled, right? And so you don't want to keep your patients waiting. But let's say you're working an eight hour day. That's pumping.
Two to three times in that window. That's 30 minutes each time. And let's say you have the luxury of having a fridge in your office. That's great. But if you don't, then you have to go store that milk somewhere. You have to clean this stuff, too. It's so I think that it It becomes like a huge time challenge, and I think we really need to re evaluate how we view new moms returning to the workplace, especially if they have that appointment based schedule and, and the volume that [00:38:00] we're expecting them to achieve in that, in that setting.
Because you're essentially asking a new mom who has a lot of stressors going on to do the same amount of work. In, I don't know, three fourths of the time, and that's another stressor that's going to make her supply potentially drop as well. Or, on the flip side, if, if she doesn't have the time to devote to that, you are depriving her and, and her baby of the, the long term benefits.
And, I do think that we know that. Physician retention when women become moms is difficult. Um, I think the AMA has a study that showed that, um, 25%, is that the right number? I have it written down somewhere. There's a huge percentage of women who leave [00:39:00] medicine within 6 years of training. So these are women who have dedicated 4 years to medical school.
They've trained fully through residency. We're in a physician shortage in our country and massive numbers of these well trained women physicians are leaving after after training because we have a old fashioned system that isn't keeping up with the physician workforce. Um, and so I think We, the reason I asked you to describe what pumping is like is because it's impossible to know before you're in it.
And so let's say you're a woman physician negotiating your contract and you've never had a baby before, but you plan to start a family. And during that first job, I think a lot of women don't advocate for themselves because they don't know [00:40:00] what to advocate for. Um, Tell me kind of what are your thoughts on that and what are some things that maybe we should be normalizing in, in jobs for women physicians or how women treat.
treat breastfeeding themselves because the other thing is the cultural part of it, right? Like, we, if we ourselves feel like we are doing a disservice to our work by taking care of our child in the most, um, basic, vital sort of way that nobody else can, and we feel immense guilt about that. And we feel that the work that we're doing is more important than that.
I think that's where moms get very, it poses a huge challenge because once you have a child, there's nothing in the world more important than that child. I'm sorry. There's just nothing that is more important than that human [00:41:00] life. And so when you're forced to choose, At the end of the day, mom is always going to choose her baby.
And if, if she's not able to choose her baby, she's going to be unhappy and she's going to be resentful to the reason that she's not able to choose her baby. So, I would just love to hear your thoughts on things that we could do in the workplace to, to support women.
Alia: Absolutely. And every workplace is very different.
That's what I've, I've learned. You know, in the hospital setting, in different practices. Um, even within the pediatric world, um, I'll just give you a little, um, story about my own self that when I had my third child, I went on maternity leave and it happened right before, you know, the pandemic happened. And I was in the process of renewing my contract with this practice and, um, essentially my boss or one of the partners at the practice called me and said, well, You have three, you're going to be, you will have three children and, and [00:42:00] I don't see you coming back full time and basically, um, you know, being able to essentially see enough patients or be invested in the practice enough to become a partner in this practice and that really, you know, was eye opening for me because as, and she was also a female physician and female pediatrician and that, As our own, you know, our, you know, female doctors themselves, if we don't prioritize what prioritize female, um, sort of, you know, the, the things that are important to, to women, and that should be important to women and mothers, who else will?
I mean, if we are in a medicine is kind of female predominant in the sense that yes, there are a lot of female graduates, the majority, you know, in pediatrics, I remember my residency program, I think was like 70 percent women. Um, but if we don't advocate for those rights and [00:43:00] those things that are important that will make, um, you know, just basic basic rights that hey, you know, female doctors should have the right toe go pump during these times or block my clinic schedule, you know, once in the morning, once in the afternoon, I'm gonna be out pumping and then, you know, move my schedule around.
If, if we don't, we don't have those rights or we don't fight for those or, um, speak up, then, then who will, you know, um, and so that was pretty eye opening that I, you know, didn't even have the support of another female physician who was also a mother and, you know, also went through this, um, so, um, sorry, going back to your question, I think that each workplace is very different, you know, in a hospital setting, you do have administration that sometimes Um, you know, has a lot of rules that, hey, this is going to be the allowed time or whatnot.
One thing that I really, you know, obviously if we look at European countries and Canada, um, and we always do kind of compare, you know, as far as maternity leave, paternity [00:44:00] leave, we don't have that in this country. We are maternity leave is if at best 12 weeks, um, you know, in residency, I was out for five weeks with my first child.
On my fifth week, I had people calling me, when are you coming back? You know, we need you. We need you back in rotation. Um, I was lucky enough to take 12 weeks with my second child. And then I was in private practice in my, during my third child maternity leave. So I took a longer period of time, but not everybody has that option.
And paternity leave is kind of unheard of in this country. Um, depending on what kind of work you do. And a lot of us with dual physician households. You know, we didn't have our partner even there because they were back to work either the next day or the same day. Sometimes they were, you know, on call or whatnot.
So just that support system isn't there. I think normalizing a, a basic amount of, you know, obviously I hope that we, our country ends up at some point getting a normal amount of, um. maternity leave that is beneficial to both baby and mom [00:45:00] to create that bond. And you know when baby's old enough, a six week old baby is not old enough to be away from their mom, especially when you're exclusively breastfeeding.
And unfortunately, that's the reality. Sometimes even sooner than that for a lot of medical professionals, they're going back at three weeks, four weeks. Um, It's just not enough time for your body to heal, um, and for, you know, to create that bond for, for the baby to be away from, from their mother biologically even.
Um, and then the other thing is that we, in this country, we don't have a lot of, um, in hospital daycares. I've, I've seen them here and there with some hospital systems. Even, um, you know, if you're in a clinic setting or private practice, obviously, you're not going to have a daycare right there, uh, in your office, but in the hospital setting, you know, for medical professions, and that goes for doctors, nurses, anyone who's working long hours, um, very rarely have I seen, and I've, I know of a few in our area, but, uh, where the hospital has a daycare or [00:46:00] some sort of childcare provided within the hospital where mom can actually go down physically, maybe feed her baby or see her baby, um, During her working hours, and I think that's something that I, I hope that, you know, in the future can become more normal, um, and then, of course, just removing that cultural stigma of breastfeeding, you know, breastfeeding in public, breastfeeding when you need to feed your baby, you're, you're providing nutrition, um, to your child, um, and just normalizing it, that it's okay, like, this is a normal part of, um, the human experience that, you know, babies need to eat and moms need to feed their babies.
So, I think just removing that cultural, um, sort of stigma as well.
Arti: Yeah, I think so. And you spoke about maternity leave. I saw a study that showed 12 weeks or more of paid leave was associated with nearly tripled likelihood of breastfeeding initiation and doubled the chance of continuing breastfeeding to six months.
So, [00:47:00] I think we do have data that supports that maternity leave supports. breastfeeding. And, um, it's something that we, we need to have the conversation about. And I love that idea of, um, in hospital daycares. I mean, I can't even imagine how tremendously different my first year of having my daughter in fellowship would have been had I had that.
But instead it was like, there was like, we had a hospital. that spanned a full city block. And there was one lactation room that if I was on one side, one part of the hospital, it would take me 15 minutes to walk to. It wasn't heated, and I did fellowship in Pittsburgh. So I, it was like, 40 degrees in there, and I remember I'd be [00:48:00] wearing my coat, shaking, and, like, I had the pump, like, obviously I couldn't be completely clothed because I had the breast pump on, like, trying to produce milk for my baby, and then I had to walk up to our fellow room.
Or like our fellow offices to refrigerate the milk and then go back to round. So this was a, you know, 45 minute process for something that could have been facilitated much more easily. And I hope that, I hope that I pumped in enough places and in front of enough people that they did something, um, about that.
Another thing that I think we sort of touched upon, but didn't. Completely flush out was the importance of like being close to your baby because there's this whole idea of oh, you could just pump I think we've identified that I've identified that pumping is not a just pump. It's it's a it's an arduous process, but [00:49:00] Is pump, is exclusively pumping really the best way to do this and is, does it make it harder?
Of course, there's some babies with latch issues where that is the only option, but should we also be considering the importance of allowing mom to spend time with her baby?
Alia: Absolutely. So I was recently just reading, um, I think there's a book. I can't remember the name, but, um, there's in every culture, you know, there's kind of this 40 day period of rest and, um, recovery for mom and bonding time.
Um, whether it's in Asian cultures, South American cultures, there's across the board, you know, there, there's a 40 day period. Is this almost one month or 40 day period where mom's supposed to rest and she should have this village of people that are supporting her and helping her. Basically she's supposed to be breastfeeding or nursing the baby and she's supposed to be taking care of.
And she shouldn't be doing kind of other things and household stuff or taking care of her other children if she has other kids. Um, [00:50:00] And culturally, over time, um, you know, the, this practice has, especially in, in the States, you know, we don't have this 40 day period, um, and a lot of people don't have that luxury of just, you know, being at home, bonding with the baby and Um, the one thing that did happen while I was in residency was that, um, our residency program changed to something what they called baby, uh, baby first or something like, I don't remember.
I trained in New York. So, um, the babies went used to initially when I was in first and second year, the babies would, um, when the infants were born, they were taken to. Uh, the newborn nursery, um, and where they would stay, you know, all, they would all be lined up real cute in their little, you know, in their little cribs, their rolly, um, little bassinets, and they would stay there, and then they would take the babies in to feed with mom.
Mom would rest, and then they would bring the babies back and change their diapers and whatever. So, what changed was that the babies then, um, would be, Uh, staying in room with moms and mom would breastfeed and keep the baby there and she [00:51:00] would change and keep the baby and spend more time with the baby in the first couple of days.
There's pros and cons to that. I feel, um, one of the things that came from that was there was a lot more what they encouraged and the nurses and the lactation consultants, uh, encouraged was the skin to skin. That helps with, you know, temperature regulation for baby, glucose regulation for baby, um, and also helps with milk production, and that skin to skin is super important where baby is unclothed, mom is unclothed, and baby, um, lies, you know, on mom or even dad, uh, and that's supposed to help in the initial phase and even over time with milk production.
So one of the things that Helps when you're pumping is that if you're not producing enough, um, you should put baby on you skin to skin and that's supposed to help your, you know, hormonal regulation and help with milk production. Um, and so if you're not with your child, um, and you're at work, obviously you can't do that.
And so, um, and I'm sure a lot of, um, non parents, [00:52:00] if anyone's listening to this, um, may have heard that, you know, when baby cries, you, you sometimes get that. feeling of like milk let down or, um, or if you hear someone else's baby cry, you know, you get that milk let down. And so. You know, mothers bodies do have a natural response to being close to the baby or hearing your baby or smelling your baby and all of those things help with milk production.
So, unfortunately, you know, when moms go back to the workforce, you are not physically with your child. Um, uh, you know, sometimes that can affect your milk production and breastfeeding and, you know, pumping and all of that. But, um, I think that, you know, If over time we are able to kind of increase that maternity time, um, maternity leave for moms where they're spending a little bit more time with their child or, you know, even just within having that flexibility with every profession and every job, uh, understanding and just having that understanding or awareness that [00:53:00] maybe the first few months when a new mom or a mom, mother comes back to work and she is breastfeeding to give her that little bit of You know, flexibility or grace, like you mentioned, um, maybe she needs to leave a little early or she needs to, you know, have a lunch break where she can go see her child or something.
I don't know. Um, but that really is, you know, a cultural change that needs to happen that, you know, I hope it comes with time. But, um, right now where we are, it's, it's a struggle, I think, for most, most working, especially for physician moms, I think, when they come back to work. And the fact that they do leave their profession, they're a big chunk of those very, um, vital, uh, members of society where they could be, you know, uh, being productive physicians and being great doctors.
Um, you know, unfortunately that, that is unfortunate that, you know, you go through all this training and then you, you end up not, um, not pursuing your career. And some of that comes with, I think that a lot of [00:54:00] moms sometimes choose to work part time or, or change their. They're the way they're practicing their profession or their their specialty.
Um, but others don't have that flexibility or can't or whatnot. So, um, I think it's it's tough. Yeah.
Arti: And I think, you know, we always want to balance. Being supportive of moms and recognizing the challenges of being a new mom and a mom in general with also not making it unpalatable for, for people to hire women because we don't want to shoot women in the foot.
But I do think, you know, there is this window that is actually rather brief, like the first year ish of a child's life is. It's actually very short. And so if we can support women physicians in those critical times, I do believe we'll build loyalty and physician recruitment is very challenging and expensive.
Um, and so I [00:55:00] think that if we can build goodwill, then I, I think we have had many economic studies on this showing that actually supporting breastfeeding can help. Help a company economically. So, um, I think that's something that we need to consider that, okay, this is a temporary window where we can support something good.
We can do good and support, support our employee or our, our partner or whatever the situation is, our resident, um, to hopefully generate goodwill for further recruitment, you know, doctors talk to each other, too. So if they're like, Oh, yeah, this place was great for me, really supportive, then that'll help recruitment and also help with further future loyalty.
So you're not in this cycle of just losing people and losing a workforce that's so, so vital, like Alia mentioned. Alia, [00:56:00] have you ever heard of the motherhood penalty?
Alia: Yes, I have. I think it's. Um, when, you know, when you become a mother, you're, um, I guess your income or your, you know, whatever, you're basically punished for being a mother, right?
Like in the workforce. So, uh, I have briefly, yes, heard of that.
Arti: Yeah. So basically it's that it's this, uh, sociological, um, phenomenon that when a woman has a baby or becomes a mother, they're perceived as, Um, being less committed, and they face decreases in pay, benefits, um, they're seen as less competent.
And it's thought that with each child, a woman gets a 4 percent pay cut compared to something that's called the fatherhood bonus. So, the fatherhood bonus is that when a man has a child, he all of a sudden is It's flipped the he's thought of as more [00:57:00] competent, more committed, and men actually get a 6 percent increase in pay for every child that they have.
As I was researching for this podcast, I found this work by Paula England that I think our listeners would would love to read on on this. And it's something that I think that we sort of know intrinsically that this is true culturally. But is hard to believe still, um, but do you think, what do you think about that?
Do you think that's, that's real? Have you experienced it? Um, just would love to kind of hear, hear your thoughts.
Alia: I think I touched on this a little bit. Um, when I mentioned my, my previous employer, um, you know, when we were renegotiating my contract to come back to work, um, she basically, you know, [00:58:00] It's told me like, you've got three children now, I don't see you being fully committed to this practice.
So that's my personal experience with, with, with that. Um, and I, I think that overall, um, you know, in every specialty, in every field, that's definitely the case. Um, especially when, you know, um, we are in male dominant, some of the male dominant Specialties. I think I don't have any personal experience with this, but as far as like orthopedics and general surgery and a lot of these procedural long hour kind of, um, kind of specialties, you know, I think female physicians sometimes are looked at as, you know, Hey, now she has a child.
Um, I don't know how committed she's going to be, or, uh, is she going to be able to physically keep up with some of the sort of physical challenges of some of these specialties as well. So, unfortunately, that is the case, I think, across the board, but as far as, you know, that was my [00:59:00] personal experience with what happened, but, you know, I think that as more and more female physicians enter, you know, our, uh, medical specialties, I think that this, this mentality has to change.
We, we can't, you know, kind of be biased against. Um, a doctor physician just because they are a mother or parent or in fact, I feel personally, I feel that if you are when you become a parent, I think your perspective on life really changes. You know, I think you become more compassionate. Um, Uh, I think I read a study once that female surgeons have, um, I mean, this is obviously very broad, but I don't remember exactly what the study was, but female surgeons have better outcomes, um, in some specialties or maybe, maybe all of them.
I don't know. Um, so I, I don't know. I think that once you become a parent, you know, your, your perspective on life changes a little bit. You do become, um, you're more, um, you're more empathetic. You're, you're, you, you know, Um, you see the world a little bit differently. You're not, you know, [01:00:00] your center of your world isn't yourself anymore.
It's, it's another human being. And so, um, I think maturity comes with that. Responsibility comes with that. And, um, I don't know, I, that's what I personally believe that I think it changes you and grounds you. And, um, hopefully, you know, I think it made me a better doctor. It definitely made me a better pediatrician.
Um, And it gives you experiences that, that help with, in my case, it helps me kind of connect with my patients and give them my experiences, like this is what worked with my child. Um, as well as giving you the perspective as a parent, as well as, you know, you're not just the doctor, but you've, you've been through it too.
So, hey, I understand.
Arti: Yeah, that empathy is huge. And, um, I don't know about the female surgeon study, but there was a study, a Harvard study that demonstrated that hospitalized patients taken care of by women physicians, when adjusted for hours worked, had, were [01:01:00] at lower risk to die. So, there is a lot of data.
Now coming out that there is value in women physicians. We bring something to the table Mothers bring something to the table for women, especially for women patients a lot of women patients prefer women physicians So there's an absolute vital role that women physicians play in our community And we're important to the physician workforce and for providing care to our communities And it's not that male physicians aren't Aren't great either, but.
We, we do provide something unique and different that is better for, for some patients, especially, um, those who relate to us in, in different ways, as far as being a woman or a woman of color or, um, different ethnicities. All of those things matter when you're a patient getting care, you want somebody who you [01:02:00] connect with.
And so, I think it's really important for us to find ways to, to keep women, all women in the workplace who want to stay in it and understand that there are women physicians who leave even though they want to stay because they can't find a, a happy balance between their work and their, their home life because we know that women are still doing the majority of child related duties as well, um, And I think the statistic is above 80 percent for both stay at home and, and working moms.
So, it is an important conversation to have. And I also think that, um, I hope our generation of women physicians is changing, but I think the previous generation, Um, they worked so hard to get where they were, and I appreciate that, and I'm so grateful that we can stand on the shoulders of what they did to work like men did in male dominant [01:03:00] fields, but I think it has led to a toxicity in the culture that they have created for women behind them and that they're like, Well, I did it.
It was cool. And it was hard for me, so I should make it hard for you. I think it's important for us as women physicians and in leadership roles, and as practice owners, to say, hey, it was really hard for me. How can I make it better for you? And how can I support you so that you can stay and blossom and grow and create a wonderful environment for yourself and your family?
So, and your patients, obviously. Um, and so, um, I hope that together we can kind of lead, lead other women to that. Um, and other women physicians to work in conjunction with each other as opposed to like, kind of beating each other down. I feel like that's, that's kind of the [01:04:00] sentiment we get from some of the older physician women.
So as we wrap up, I was just wondering, is there anything that you wanted to say that you didn't have a chance to say or anything that you have as a message to new physician moms or physicians who want to be moms to help them advocate for themselves on their breastfeeding journey? I
Alia: think we touched on majority of kind of everything I wanted to say.
Um, and we talked about a lot of different things. Um, I think just ending on a note that, Um, you know, I think it is a cultural change. I think in the workplace and in, you know, the hospital setting in our training programs for for new moms position, new moms. Um, it is a shift in culture that that needs to take place that, um, we need to normalize breastfeeding, that this is something that, [01:05:00] um, that happens, that this is It's part of the world.
It's, it's a normal thing. And, um, just to, to give those new moms a little bit of support and flexibility, um, so that, so that, you know, and, and also to touch on, um, breastfeeding is also like preventive, right? Like in the long scheme of things, when we talk about preventive medicine, um, doing things, you know, as adults, we, we are now more aware of, you know, exercise and lifestyle changes that we make.
for our own selves, the foods that we consume and so many things. And a lot of people are very hyper focused on health and all of those things. But overall, in the scheme of things, breast milk is actually And so, um, I think that's extremely beneficial to the next generation of kids, Children, you know that are going to come and, um, if we don't establish it, or if we don't, you know, uh, sort of make it a priority, Um, you know, it's that would be kind of sad that we don't take that full benefit.
And so [01:06:00] just as we're as a society as we're changing into more healthier preventive society, we're focusing on preventive health. But part of that is breast feeding. And, um, and I hope that that is given. the importance that it deserves.
Arti: Yes. Oh my gosh. Thank you so much for being here with us today and for everything that you said, especially that last piece as we talk so much about lifestyle medicine after the fact.
I mean, there's so many things that we can do for our children and for the next generation in utero and with breastfeeding that, um, I don't know that. people know enough about. So I think that was a great point. So thank you very, very [01:07:00] much.

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