Stories are just data with a soul - Brené Brown
380 reports of maternal discrimination → 199 narratives shared → 645 individual codes applied
Abusive work environment / scheduling
Anxiety concerning fertility
Blatant discrimination (verbal or otherwise)
Barriers to making/attending child appointments
Different behavioral expectations
Discrimination regarding desire to get pregnant/grow a family
Gaslighting
Inability to pump adequately during work
Lack of interpersonal support for lactation/pumping
Lack of support during pregnancy or postpartum
Inadequate maternity leave
Passive discrimination
Positive experiences
Barriers to accessing & attending prenatal care
Lack of adequate pumping spaces
Unsafe working conditions (ex: deliberate exposures, frequent call)
Overt acts of discrmination from program director
Pressure from program director (ex: harassing postpartum trainee to come back early)
Psychological costs
Health consequences (ex: preeclampsia, preterm delivery)
Shortened breastfeeding journey
Violations of privacy (ex: PD/peers opening trainee's chart)
Peer resentment
Inadequacy / non-existence of parental/paternal leave
Maternity leave not respected
Withholding benefits
Inaccurate interpretation of benefits & rights (ex: programs withholding information or disregarding ACGME/board rules)
Assumption that femaleness equates to desire to have children
By codifying new and emerging patterns, the expansive experience of maternal discrimination was further characterized. The voices of the participants are forever held together by this common thread.
Desired changes to the culture and structure of medical training were shared. Unifying themes emerged:
Standard, 12-week leave across all specialties for parents.
Proper execution of policies and labor rights.
Transparent leave policies
Standard, inclusive lactation policies and protection.
Require clean, accessible lactation spaces & time to pump.
NP/PA support during leave to decrease the burden on other residents and thus mitigate resentment and perpetuation of a toxic environment.
Have faculty/admin demonstrate competence in basic understanding of lactation physiology and needs of a pumping person in the workplace.