Pumped for Policy: A Cross-Sectional Survey of Doctors within Ireland’s Public Health System on Breastfeeding Policy and Practice in the Medical Workforce

Pumped for Policy: A Cross-Sectional Survey of Doctors within Ireland’s Public Health System on Breastfeeding Policy and Practice in the Medical Workforce | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Pumped for Policy: A Cross-Sectional Survey of Doctors within Ireland’s Public Health System on Breastfeeding Policy and Practice in the Medical Workforce Jian Mae Mah, Fiona Lemasney, Elizabeth Barrett, Peter Barrett This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9293333/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 14 You are reading this latest preprint version Abstract Background Physician mothers face unique barriers to breastfeeding despite clinical knowledge of its benefits, including inflexible schedules, limited lactation support, and cultural biases. Despite the many maternal and infant benefits, structural workplace barriers often cause early cessation, especially after returning to clinical duties. These challenges contribute to reduced maternal satisfaction and professional dissatisfaction. This study explores the breastfeeding experiences of physicians in Ireland and assesses whether workplace policies meet their needs. Methods A national, cross-sectional mixed-methods survey was developed, adapted from validated international tools. It captured responses across specialities, including consultants (32.89%) and general practitioners (13.82%). Statistical analyses included Chi-square, Mann–Whitney U, McNemar, and Spearman’s rank tests. Results Findings highlight a persistent gap between the Health Service Executive (HSE) Breastfeeding Policy for Staff and clinical workplace realities. While initiation was high with 86.18% (n = 131), continuation at work was far lower, with only 30.26% (46) breastfeeding or expressing during clinical hours. Few felt adequately supported: 21.05% (32) rated lactation spaces as supportive, and 23.68% (36) reported feeling well-informed about their entitlements. Although 14.47% (22) said flexible break options were available, ratings across all policy supports remained uniformly low, with fewer than one in five respondents finding any domain supportive. Conclusion These results underscore how insufficient facilities, limited time, and cultural stigma continue to undermine breastfeeding goals among healthcare professionals. These findings suggest a need for systemic reform to ensure that stated HSE policies result in tangible workplace improvements. Breastfeeding physician mothers breastfeeding self-efficacy workplace support Healthcare workforce Figures Figure 1 Figure 2 Introduction Breastfeeding is a foundational component of public health with well-established benefits for infants including enhanced immunity, cognitive development, bonding, and lower risk of later non-communicable disease as well as reduced maternal morbidity, conferring advantages of reduced postpartum hemorrhage and lower risks of breast and ovarian cancers (Health Service Executive & Association of Lactation Consultants in Ireland, 2016; World Health Organization, 2022 ; Health Service Executive National Breastfeeding Implementation Group, 2024). The World Health Organization recommends exclusive breastfeeding for six months and continued breastfeeding to two years or beyond (WHO & United Nations Children's Fund, 2021). Despite the evidence supporting breastfeeding as a key moderator of infant and maternal health, Ireland's rates of breastfeeding initiation and continuation are amongst the lowest in the world (Health Service Executive, National Women and Infants Health Programme, 2023 ). Improving breastfeeding rates is recognised as a national public health priority in Ireland. This is indicated by government policy and investment designed to strengthen breastfeeding supports (Department of Health, 2024 ). The HSE Breastfeeding Action Plan, extended to 2025, is the national framework for advancing breastfeeding support in Ireland, which set a target of increasing breastfeeding rates by 2% annually. Breastfeeding policy is indicated as a priority in the Programme for Government 2025, which sets out a government-wide approach including funding for community initiatives, increasing lactation consultant provision in hospitals and communities, and supporting voluntary breastfeeding groups (Department of the Taoiseach, 2025 , p. 64) alongside a separate commitment to invest in additional breastfeeding supports (Department of the Taoiseach, 2025 , p. 88). National prevention frameworks also explicitly include breastfeeding as part of long-term child health and obesity prevention strategies (Department of Health, 2013 ; Department of Health, 2016 ). Workplace policy is a key area to improve breastfeeding rates in Ireland and this is supported by governmental legislation, which has recently expanded workplace rights. Since July 2023, statutory paid breastfeeding breaks can now extend up to 104 weeks (2 years) postpartum (DoCEDIY, 2023). HSE policy protects lactation breaks and statutory leave. (HSE NBIG, 2020; HSE NBIG, 2024; WHO, 2022; Health Service Executive, 2016 ; Paul et al. 2024 ). However, qualitative Irish evidence suggests workplace breastfeeding remains culturally constrained, with women reporting stigma, inconsistent advice, and concealment of breastfeeding at work due to embarrassment and perceived lack of employer support. This highlights deficits in implementation rather than policy as a fundamental factor in continued low rates of breastfeeding (HSE NBIG, 2024; World Breastfeeding Trends Initiative Ireland Core Group, 2023 ) (Desmond & Meaney, 2016 .) There has been a notable lack of research evaluating how clinician mothers in Ireland experience breastfeeding in the workplace and how workplace conditions align with national policy and statutory entitlements, within HSE settings (Desmond & Meaney, 2016 ; HSE NBIG, 2020; HSE NBIG, 2024; HSE NDTP, 2024). To our knowledge, no national study has explored the return-to-work breastfeeding journeys of Irish physicians, creating a significant gap in both academic literature, policy development, and resourcing of effective supports (HSE, 2016; French et al. 2022 ). This can also make it harder to continue breastfeeding after return to work, despite breastfeeding being a stated national public health priority in Ireland. (DoH, 2024; HSE NBIG, 2024). We therefore examine breastfeeding continuation after return to work among Irish physicians by assessing workplace accommodations and policy awareness, and measuring feeding outcomes at return. Methods A voluntary, mixed-methods survey was administered on SurveyMonkey (encrypted, industry-standard security) incorporating both quantitative and qualitative questions. Ethics exemption was granted by University College Dublin (UCD); participants provided informed consent. Survey was piloted twice and opportunistic sampling was used. Recruitment occurred via the "Doctors as Parents" Facebook group, the Forum of Irish Postgraduate Medical Training Bodies, the Women in Medicine in Ireland Network (WiMIN), LinkedIn, and X (Twitter). Data collection ran from July 4 to July 18, 2025. The questionnaire drew on prior instruments (Frolkis et al. 2020 ; Kevric et al. 2022 ; Sattari et al. 2020 ) examining similar populations and incorporated HSE Breastfeeding Policy for Staff language into operational items (HSE NBIG, 2020), standardizing response scales (Likert 0–4; Yes/No; multi-select) and removing duplicates identified during the two pilot rounds. Quantitative analyses were performed in Excel and Python (two-sided tests). Descriptive statistics were computed for breastfeeding initiation, duration, complications, and perceived workplace support scores. Eligibility targeted physicians in Ireland who had breastfed and returned to work. The survey covered five domains: (1) demographics (specialty, role, number of children); (2) breastfeeding practices (breastfeeding initiation, duration, intentions/goals, complications); (3) workplace accommodations (e.g., lactation rooms, protected breaks, storage options, scheduling flexibility); (4) policy awareness (e.g., HSE Breastfeeding Policy); and (5) cultural attitudes (perceived support from supervisors and peers). Items were a mix of closed-ended (Likert; Yes/No) and open-ended questions. Awareness of the existence of the HR117 process in the policy was scored 0 = Not aware, 1 = Partially aware, 2 = Fully aware; the main comparison contrasted no awareness (n = 86) with any awareness (n = 66). The HR117 process refers to a documented HR pathway that includes a standard form and a defined procedure to notify return-to-work, and to formally arrange lactation breaks, a private space and milk storage, with an identified contact person and written confirmation of the arrangement. Availability of 16 HSE policy-aligned supports (e.g., paid breaks, flexible scheduling, lactation rooms, facilities, training, HR117 process, review of arrangements, cooler bags/ice packs) was rated 0 = No, 1 = In part, 2 = Yes. Analyses used per-item denominators; "Don't know/not applicable" and blanks were excluded. Perceived workplace support was assessed across nine domains (e.g., work culture, time to express, supervisor communication, on-call duties, career protection, access to HSE Breastfeeding Policy rights). Access to rights' assessed awareness of statutory/HSE entitlements, clarity of the access pathway (HR117), and the ability to take protected breaks and use appropriate facilities without adverse consequences. Each was rated on a 0–4 Likert scale, with analyses reporting mean scores and the proportion rating < 3 (unsupportive; <3 = scores 0–2). Item-level denominators varied due to missing data. Breastfeeding complications items from Q16 (e.g., engorgement, clogged ducts, mastitis, abscess, difficulty expressing during extended work) were rated 0–4 severity (0 = None; 4 = Severe). For each complication, we report the mean severity score and the proportion classified as moderate-severe (scores 3–4). Associations between policy awareness and availability of supports (0–2 items) were tested using Chi-square (χ² ) with Cramer's V and Mann-Whitney U. For Mann-Whitney U, awareness was grouped 0 vs 1–2. χ² used 3×3 contingency tables (awareness 0/1/2 × availability 0/1/2; df = 4). Spearman's rank correlation examined workplace supportiveness (0–4 domains) and breastfeeding continuation after return to work. Changes in exclusive breastfeeding from birth to return to work were assessed with McNemar's test (paired binary), two-sided. Our primary return-to-work outcome was human-milk only (no formula); we also repeated the analysis using a stricter WHO definition (no solids or formula). Breastfeeding continuation at return to work was defined from the Q13 item 'Were you breastfeeding when you returned to work after your most recent childbirth?' (Yes = 1, No = 0). Analyses used per-item denominators; 'Don't know/not applicable' and blanks were excluded. All tests were two-sided with α = 0.05; p-values are unadjusted for multiple comparisons given the exploratory aims, and exact values are reported (when p < 0.001, we report 'p < 0.001' rather than a rounded value). Results At return to work, 85.53% (130/152) were breastfeeding; human-milk only (no formula) at return was 15.79% (24/152). Comparing respondents with no awareness of HSE breastfeeding policies (score = 0; n = 86) to those with partial or full awareness (scores = 1-2; n = 66), all 16 policy-aligned items showed higher reported availability among those with awareness (Mann-Whitney U: p <0.001 for most; "Regular review" p = 0.002; and "Cooler bags/ice packs" p = 0.008). Chi-square (χ²) tests on 3×3 tables showed consistent results, with moderate associations for key items: "Access to training/resources" (χ² = 72.65, V = 0.49); "Opportunity to negotiate breaks" (χ² = 68.46, V = 0.47); and "Information on expression/storage" (χ² = 54.38, V = 0.42) [Insert Table 1 here]. Breastfeeding continuation after return to work was positively correlated with several workplace support factors: "Career protection" (ρ = 0.24, p = 0.003); "Reduced on-call impact" (ρ = 0.23, p = 0.005); "Comfort expressing at work" (ρ = 0.22, p = 0.009); "Overall workplace support" (ρ = 0.22, p = 0.009); "Reduced guilt/inconvenience" (ρ = 0.21, p = 0.011); "Sufficient time to express" (ρ = 0.20, p = 0.013); "Assistance accessing rights" (ρ = 0.20, p = 0.016); "Comfort communicating with supervisors" (ρ = 0.17, p = 0.038); and "Work culture & colleague attitudes" (ρ = 0.17, p = 0.047) [Insert Table 2 here]. Perceived workplace support (0-4) was rated poorly across all nine domains, with mean scores ranging from 0.66 to 1.21. Most respondents rated each domain as unsupportive (<3), with proportions exceeding 80% in all areas. The lowest-rated domain was for "Support in accessing HSE rights without self-advocacy" with 88.97% (129/145; mean = 0.66) of respondents rating it unsupportive, followed by "Sufficient time during work hours to express" with 88.44% (130/147; mean = 0.79). Even the most positively rated domain, "Work culture & colleague attitudes," still received a mean of only 1.21, with 81.38% rating it unsupportive (118/145) [Insert Figure 1 here]. Denominators varied slightly across domains due to item non-response (range: n = 145-147). Overall, fewer than one in five respondents rated any workplace support domain as adequate (≥3), underscoring widespread deficits. Work-related breastfeeding complications were frequently reported: Moderate/severe burden (scores 3-4; item specific denominators on 0-4 scale) was highest for "Decreased sleep" with 62.91% (95/151, mean 2.67) and "Difficulty expressing due to extended work periods" with 52.98% (80/151, mean 2.23), followed by "Breast engorgement" with 37.09% (56/151, mean 1.81). Psychological strain was common but typically less intense: "Burnout/work stress" = 29.80% (45/151, mean 1.64) and "General anxiety" = 28.29% (43/152, mean 1.60). Clinical complications were less frequently rated as moderate/severe: "Clogged ducts" = 23.03% (35/152, mean 1.16), "Mastitis" = 13.16% (20/152, mean 0.72), "Postpartum depressive symptoms" = 7.95% (12/151, mean 0.53), and "Breast abscess" = 1.99% (3/151, mean 0.09). Many respondents linked complications to missed or delayed feeds during work, consistent with occupational risk for physician mothers [Insert Figure 2.1 and 2.2 here]. Discussion This study is the first to examine breastfeeding practices among physicians in Ireland. Exclusive breastfeeding (EBF) at birth was high (86.18%, 131/152) − after return to work, most participants were still breastfeeding (85.53%, 130/152), yet only 15.79% (24/152) reported providing human-milk only (no formula), indicating a substantial shift towards formula/mixed feeding on return to work (McNemar χ²=106.01, p < 0.001). Using a stricter WHO definition at return (no solids or formula), the estimate was 7.89% (12/152) (p < 0.001). Because most returns occur at ≥ 6 months in Ireland when complementary foods are typically introduced, we treat human-milk only (no formula) at return as the outcome that best reflects the impact of workplace supports (time, space, storage). This framing aligns with Irish prevention policy, which positions breastfeeding as a long-term child-health measure, including prevention of childhood infectious disease and obesity (DoH, 2013; DoH, 2016). These findings are especially salient in the current Irish context: Ireland's WBTi assessment describes a moderate policy/programme framework, yet breastfeeding practice indicators remain poor, suggesting an implementation gap rather than policy absence (WBTiICG, 2023). National indicators remain low (32% exclusive breastfeeding at three months) (HSE NBIG, 2024), and routine surveillance beyond ~ 3 months postpartum is limited, restricting evaluation of interventions and identification of subgroups requiring additional support (WBTiICG, 2023). Although national breastfeeding supports, training initiatives, and workplace entitlements have expanded (including extension of statutory workplace breastfeeding breaks to two years postpartum), translation into day-to-day practice in high-intensity clinical settings may be inconsistent (HSE NBIG, 2024; DoCEDIY, 2023). Workplace stigma, inconsistent support and unclear enforcement of rights, are especially relevant upon return to work, and can disrupt feeding plans and increase mental health strain (Desmond & Meaney, 2016 ; French et al. 2022 ; Frolkis et al. 2020 ; Vilar-Compte et al. 2021 ; Knutson & Butler, 2022 ). At a systems level, paid, protected expressing breaks of six months or longer are associated with higher exclusive breastfeeding (≈ 8.9 percentage-point increase), underscoring the role of concrete workplace policy in supporting breastfeeding and the downstream long-term health benefits for mothers and children (Heymann et al. 2013 ). Our results mirror international physician data linking re-entry to early cessation when protected time and private space are scarce (Frolkis et al. 2020 ; Kevric et al. 2022 ; Riggins et al. 2012 ; Sattari et al. 2020 ). In our sample, 19.08% (29/152) reported not meeting a breastfeeding goal for at least one child. At the same time, 62.50% breastfed beyond one year and 23.03% beyond two; impressive in an Irish context whereby breastfeeding > 1 year is far from the norm, suggesting strong motivation amid persistent systemic barriers (Paul et al. 2024 ; WHO, 2022). Taken together, strong overall breastfeeding duration alongside a sharp drop in milk-only feeding upon return to work supports a structural/workplace constraint interpretation, rather than a lack of motivation (WBTiICG, 2023), occurring in a context of heightened burnout risk among women clinicians (Eischen et al. 2022 ; Haffizulla et al. 2020 ; Lyubarova et al. 2023 ). Continuation after return to work also appeared sensitive to workplace conditions across children; among respondents with more than one child (n = 119), 36.13% (43/119) reported that workplace factors moderately or strongly influenced how breastfeeding went across children, whereas 42.86% (51/119) reported no effect. This pattern suggests differences by site, rota, and supervisor, and is also seen in North American and Australasian cohorts arguing for standardized, default processes over self-negotiation (Castillo-Angeles et al. 2022 ; French et al. 2022 ; Frolkis et al. 2020 ; Kevric et al. 2022 ; Sattari et al. 2020 ). This is particularly important for trainees who face the greatest power asymmetries (Haffizulla et al. 2020 ; Lyubarova et al. 2023 ). Perceived workplace support across nine domains was uniformly low (means 0.66–1.21/4), with fewer than 20% of participants rating any domain as supportive (≥ 3). The worst-rated areas, which were "Support in accessing HSE rights without self-advocacy" (88.97% unsupportive; 11.03% supportive [≥ 3]) and "Sufficient time during work hours to express" (88.44% unsupportive; 11.56% supportive), map directly to the day-to-day policy implementation gaps in clinical work, that intensify stress and elevate mental-health risk (HSE NBIG, 2020; Vilar-Compte et al. 2021 ; Fantasia, 2024 ; Sattari et al. 2020 ; Bye et al. 2022 ). In practical terms, this mismatch implies that having policy, funding, and statutory rights in place does not reliably translate into predictable time, space, storage, and managerial support for doctors on the ground (HSE NBIG, 2024; DoCEDIY, 2023; DoH, 2024). Consistent with prior physician literature, awareness of HSE policy rights coincided with greater availability of concrete supports across all 16 items (Mann-Whitney U: p < 0.001 predominantly; parallel χ² tests showed moderate associations), indicating that policy knowledge and implementation tend to co-occur (Fantasia, 2024 ; Knutson & Butler, 2022 ; Tomori, 2022 ). Continuation also correlated modestly but consistently (ρ = 0.17–0.24) with career protection, reduced on-call impact, comfort expressing, time/space to express, supervisor communication, overall support, assistance accessing rights, and team culture. These domains map to modifiable determinants repeatedly observed among physicians: fear of career penalty, scheduling rigidity, and stigma around requesting breaks or space (Caperelli Gergel & Terry, 2022 ; Castillo-Angeles et al. 2022 ; French et al. 2022 ; Sattari et al. 2020 ; Tomori, 2022 ; Vilar-Compte et al. 2021 ). Reported complications including engorgement, difficulty expressing due to extended work periods, clogged ducts, mastitis, and breast abscess, are consistent with infrequent milk removal under workload pressure. These harms jeopardise maternal health and service continuity and hasten weaning, undermining the benefits underpinning WHO recommendations (HSE & ALCI, 2016; Tomori, 2022 ; WHO, 2022). Equity concerns arise when access hinges on self-advocacy, disadvantaging earlier trainees or less supported teams (Knutson & Butler, 2022 ; Vilar-Compte et al. 2021 ). Among those returning to work when infants were 6–12 months old, majority (92.86%) were non-exclusive, most of whom were partially breastfeeding, with EBF being 7.14% (8/112), which likely reflects both complementary feeding by ~ 6 months and workplace constraints that make exclusivity harder to sustain. Policy implications are therefore implementation-first: protected expressing time, predictable cross-cover on rounds/procedures, private/lockable spaces with sanitation and cold storage, and manager training to normalize rights and reduce stigma. Prioritizing assistance in accessing rights without self-advocacy and time to express should be central to HSE updates, given their strong deficits. Breastfeeding outcomes after return to work are strongly influenced by how well workplaces support lactation, with downstream implications for gender equity and workforce retention (Haffizulla et al. 2020 ; Lyubarova et al. 2023 ; Sarma et al. 2024 ). Within medicine, women physicians face distinct burnout pressures related to workload, recognition of value and perceived worth, and work-family conflicts. This is particularly important in Ireland given the gender profile of Irish doctors. Female trainees are in the majority (53% Intern, 57% Basic Specialist Training, 54% Higher Specialist Training; 55% total) in contrast to a male-majority consultant cohort (41% female). (Health Service Executive, 2024) Poor lactation accommodation at re-entry risks disrupting women's return and progression while amplifying stress, sleep loss, anxiety and PPD (Eischen et al. 2022 ; Haffizulla et al. 2020 ; Hoang Roberts et al. 2024 ; HSE NDTP, 2024; Lyubarova et al. 2023 ; Sattari et al. 2020 ). It is established that increasing workplace supports, such as ensuring protected time and space to express, facilitates women to sustain breastfeeding, reduces the risk of gendered burnout and related mental health consequences, thus supporting retention. (Fantasia, 2024 ; French et al. 2022 ; Haffizulla et al. 2020 ; Lyubarova et al. 2023 ; Sarma et al. 2024 ; Tomori, 2022 ; Vilar-Compte et al. 2021 ). In this context, workplace lactation support is not simply an individual "accommodation," but a basic workplace condition that can shape gender equity, influencing training progression, retention, and the sustainability of the medical workforce. As it is a primary, exploratory study, utilizing cross-sectional and self-reported data as well as possible self-selection, causal interference and generalizability is limited. The high rates of EBF observed in our sample may not be representative or generalizable to a wider sample due to the opt-in bias introduced by opportunistic sampling. Also, planned subgroup analyses by career stage and specialty were not pursued because group sizes were small and estimates imprecise; any comparisons are presented descriptively only. However, convergence across awareness, availability, support, complications, and continuation strengthens internal consistency. Future research should combine quantitative and qualitative methods in larger, more diverse samples, and evaluate the impact of targeted interventions, particularly within training programs, on breastfeeding outcomes. Larger samples are needed to test differences by career stage and specialty. Given national gaps in post-discharge surveillance, future evaluations should include standardized measurement of infant feeding outcomes beyond 3 months postpartum where feasible, alongside implementation measures (availability, accessibility, and usability of supports) and workforce outcomes (absence, intention to stay, retention) (WBTiICG, 2023). In practical terms, our data point to real-world fixes; rostered, protected breaks to express with predictable cross-cover, private lockable spaces with sanitation and cold storage, and proactive manager/HR processes, to sustain breastfeeding at work without compromising patient care. Declarations Human Ethics and Consent to Participate : The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committee on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008. The authors assert that the local ethics committee has determined that ethical approval for publication of this original research has been provided by their local Ethics Committee; Ref. No.: UTMREC- SM-E-25-631-Mah-Barrett. Informed consent to participate in the study was obtained from all participants Consent for publication: not applicable Availability of data and materials: The datasets generated and/or analysed during the current study are not publicly available due to privacy concerns for the survey participants but are available from the corresponding author on reasonable request. Funding Declaration: This research received no specific grant from any funding agency, commercial or not-for-profit sectors. Competing Interests: The author(s) declare none. Authors' contributions This study was conceptualized and designed by Dr. Elizabeth Barrett and Dr. Fiona Lemasney, building on previous literature reviews and work with expert by experience groups. Jian Mae Mah, Dr. Fiona Lemasney and Dr. Elizabeth Barrett contributed to survey development and piloting and dissemination. The first author Jian Mae Mah performed all quantitative analyses, created all figures and tables (adapted from SurveyMonkey outputs where applicable), and produced the first manuscript draft in collaboration with Dr. Lemasney. Dr Peter Barrett reviewed the paper and provided comments and suggested amendments. Acknowledgement: The author wishes to acknowledge the “Doctors as Parents” Facebook Group, Dr. Sarah Fitzgibbon of Women in Medicine in Ireland Network, Dr. Sarah Brennan from the University ofGalway, and Jack O’Flanagan from the Forum of Irish Postgraduate Medical Training Bodies, for their help in promoting the survey, as well as the UCD SSRA Office for this project opportunity. References Bye E, Leval R, Sayles H, Doyle M, Mathes M, Cudzilo-Kelsey L (2022). Parental postpartum depression among medical residents. Archives of Women's Mental Health 25 , 1129-1135. (https://doi.org/10.1007/s00737-022-01271-3). Accessed 30 August 2025. Caperelli Gergel MC, Terry DL (2022). Giving 200%: Workplace Flexibility and Provider Distress Among Female Physicians. Journal of Healthcare Leadership 14 , 83-89. (https://doi.org/10.2147/JHL.S359389). Accessed 5 August 2025. Castillo-Angeles M, Atkinson RB, Easter SR, Gosain A, Hu YY, Cooper Z, Kim ES, Rangel EL (2022). 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Breastfeeding policy: a globally comparative analysis. Bulletin of the World Health Organization 91 , 398-406. (http://dx.doi.org/10.2471/BLT.12.109363). Accessed 18 September 2025. Hoang Roberts LN, Zwaans BMM, Vollstedt A, Sharrak A, Han E, Fischer M, Sirls L, Padmanabhan P (2024). Maternity Leave Satisfaction Among Physicians Compared with Nonphysician Professionals. Journal of Women's Health 33 , 33-38 (https://doi.org/10.1089/jwh.2023.0054). Accessed 30 August 2025. Kevric J, Suter K, Hodgson R, Chew G (2022). A survey of Australian and New Zealand medical parents' experiences of infertility, pregnancy, and parenthood. Frontiers in Medicine 9 , 943112. (https://doi.org/10.3389/fmed.2022.943112). Accessed 5 August 2025. Knutson J, Butler J (2022). Providing Equitable Postpartum Breastfeeding Support at an Urban Academic Hospital. Nursing for Women's Health 26 , 184-193. (https://doi.org/10.1016/j.nwh.2022.03.002). Accessed 6 August 2025. Lyubarova R, Salman L, Rittenberg E (2023). Gender Differences in Physician Burnout: Driving Factors and Potential Solutions. The Permanente Journal 27 , 130-136. (https://doi.org/10.7812/TPP/23.023). Accessed 22 September 2025. Paul G, Vickers N, Kincaid R, McGuinness D (2024). 'It's far from the norm': breastfeeding beyond 1 year in the Republic of Ireland. Health Promotion International 39 , daae088. (https://doi.org/10.1093/heapro/daae088). Accessed 15 August 2025. Riggins C, Rosenman MB, Szucs KA (2012). Breastfeeding experiences among physicians. Breastfeeding Medicine 7 , 151-4. (https://doi.org/10.1089/bfm.2011.0045). Accessed 5 August 2025. Sarma D, Chiu DT, Kimball AB (2024). Gender and Clinical Status in Burnout in Medicine. JAMA Network Open 7 , e246575 (https://doi:10.1001/jamanetworkopen.2024.6575). Accessed 22 September 2025. Sattari M, Levine DM, Mramba LK, Pina M, Raukas R, Rouw E, Serwin JR (2020). Physician Mothers and Breastfeeding: A Cross-Sectional Survey. Breastfeeding Medicine 15 , 312-20. (https://doi.org/10.1089/bfm.2019.0193). Accessed 5 August 2025. Tomori C (2022). Overcoming barriers to breastfeeding. Best Practice & Research Clinical Obstetrics & Gynecology 83 , 60-71. (https://doi.org/10.1016/j.bpobgyn.2022.01.010). Accessed 15 August 2025. Vilar-Compte M, Hernández-Cordero S, Ancira-Moreno M, Burrola-Méndez S, Ferre-Eguiluz I, Omaña I, Pérez Navarro C (2021). Breastfeeding at the workplace: a systematic review of interventions to improve workplace environments to facilitate breastfeeding among working women. International Journal for Equity in Health 20 , 110. (https://doi.org/10.1186/s12939-021-01432-3). Accessed 15 August 2025. World Breastfeeding Trends Initiative Ireland Core Group (2023). Assessment Report: Ireland 2023. (https://www.worldbreastfeedingtrends.org/uploads/country-data/country-report/WBTi-Ireland-2023.pdf). Accessed 29 January 2026. World Health Organization, United Nations Children's Fund (2021 ). Global Breastfeeding Scorecard 2021: protecting breastfeeding through bold national actions during the COVID-19 pandemic and beyond. Geneva: World Health Organization. (https://iris.who.int/bitstream/handle/10665/348546/WHO-HEP-NFS-21.45-eng.pdf?sequence=1). Accessed 15 August 2025. World Health Organization (2022). Infant and young child feeding . Geneva: World Health Organization. (https://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding). Accessed 15 August 2025. Table 1 Table 1. Comparison of Workplace Breastfeeding Supports by Policy Awareness. Scores range from 0 = No, 1 = In part, 2 = Yes. Group comparisons were made between participants with no awareness of their rights (score = 0; n = 86) and those with partial or full awareness (score = 1 or 2; n = 66). Mann-Whitney U tests compare the distribution of scores between groups (U = test statistic). For categorical comparisons: χ² tests used 3×3 contingency tables (awareness 0/1/2 × availability 0/1/2; df = 4) and Cramer's V = effect size (0 = No association, 1 = Perfect association). Higher mean scores indicate greater reported access to the workplace breastfeeding support item. For the Mann-Whitney U test, p-values were <0.001 for 14/16 items, except: "Regular review of breastfeeding arrangements (e.g., after 1 month, then quarterly)" (p = 0.002) and "Access to cooler bags and ice packs for milk transport" (p = 0.008). For the χ² tests, p-values were <0.001 except: "Regular review of breastfeeding arrangements (e.g., after 1 month, then quarterly)" (p = 0.002) and "Access to cooler bags and ice packs for milk transport" (p = 0.005). Bold rows highlight items with higher p-values but still statistically significant at p <0.05. HSE Policy Support Item Mean Score (No Awareness) Mean (Partial/Full Awareness) U Statistic χ² value Cramer's V Opportunity to discuss and negotiate how breastfeeding breaks would be taken 0.09 0.94 1212.00 68.46 0.47 Access to training or resources related to breastfeeding policy and rights 0.01 0.64 1575.00 72.65 0.49 Paid breastfeeding breaks (up to 1 hour per day) 0.09 0.74 1563.00 42.41 0.37 Flexibility in how breaks were taken (e.g., 60 min, 2×30 min, or 3×20 min) 0.17 0.83 1585.00 42.40 0.37 Support from line manager to facilitate breastfeeding breaks 0.12 0.71 1707.50 45.30 0.39 Availability of information on expressing and storing breast milk 0.05 0.56 1912.00 54.38 0.42 Access to handwashing facilities and a chair in the lactation space 0.23 0.89 1725.00 40.67 0.37 Access to private, lockable, hygienic, comfortable, and appropriately equipped lactation room (not a toilet) 0.21 0.82 1726.00 40.42 0.36 Availability of information on how to store, transport, and safely use expressed milk at home 0.06 0.56 1964.50 52.15 0.41 Managerial support in arranging breastfeeding breaks and facilities 0.14 0.62 1853.00 44.74 0.38 Access to a fridge to store expressed breast milk 0.28 0.89 1754.00 29.39 0.31 Ability to apply using HR117 form at least 4 weeks before return to work 0.03 0.45 2085.50 25.98 0.29 Encouragement to maintain breastfeeding upon return to work 0.07 0.52 2022.00 30.42 0.32 Option to reduce the working day by 1 hour (if no suitable space available) 0.06 0.45 2100.00 21.21 0.26 Regular review of breastfeeding arrangements (e.g., after 1 month, then quarterly) 0.02 0.18 2487.00 16.89 0.24 Access to cooler bags and ice packs for milk transport 0.08 0.32 2437.00 14.77 0.22 Table 2. Correlation Between Workplace Supportiveness and Continued Breastfeeding at Work. This table shows the association between perceived workplace supportiveness and rates of continued breastfeeding among participants. Spearman’s rank correlation (p) between perceived workplace supportiveness and continuation of breastfeeding upon return to work. Spearman's ρ = Spearman rank correlation coefficient, measuring the association between perceived workplace support (0-4; 0 = Not at all supportive, 4 = Extremely supportive; item-level n shown) and continuation of breastfeeding after return to work (Yes = 1, No = 0). Positive values indicate that higher perceived support is associated with a greater likelihood of continuing breastfeeding. All reported correlations were statistically significant at p <0.05; 4 of 9 were p<0.01 ("career protection", "on-call impact", "comfort expressing", and "overall support"). Exact p-values are reported for each domain. Workplace Support Item Spearman's ρ p-value n Supportive environment that protected career progression while breastfeeding 0.24 0.003 146 Impact of on-call duties on your ability to breastfeed or express milk 0.23 0.005 146 Workplace support in helping you feel comfortable expressing during work hours 0.22 0.009 146 Support from workplace (formal policies and informal support) 0.22 0.009 147 Workplace support in reducing feelings of guilt or inconvenience when breastfeeding or expressing at work 0.21 0.011 146 Sufficient time during work hours to express milk 0.20 0.013 147 Support from workplace in helping you access your HSE breastfeeding rights without needing self-advocacy 0.20 0.016 145 Comfort communicating breastfeeding needs with supervisor 0.17 0.038 147 Work culture & colleague attitudes regarding breastfeeding 0.17 0.047 145 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 12 May, 2026 Reviewers agreed at journal 11 May, 2026 Reviews received at journal 11 May, 2026 Reviewers agreed at journal 11 May, 2026 Reviewers agreed at journal 11 May, 2026 Reviewers agreed at journal 11 May, 2026 Reviews received at journal 11 May, 2026 Reviewers agreed at journal 11 May, 2026 Reviewers agreed at journal 18 Apr, 2026 Reviewers invited by journal 18 Apr, 2026 Editor invited by journal 15 Apr, 2026 Editor assigned by journal 14 Apr, 2026 Submission checks completed at journal 14 Apr, 2026 First submitted to journal 01 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9293333","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":628955491,"identity":"b502433c-50a8-4f95-9eb5-84d745ff59ee","order_by":0,"name":"Jian Mae Mah","email":"","orcid":"","institution":"University College Dublin","correspondingAuthor":false,"prefix":"","firstName":"Jian","middleName":"Mae","lastName":"Mah","suffix":""},{"id":628955492,"identity":"3bebc771-b053-4467-8c0c-dd82c2c919b4","order_by":1,"name":"Fiona Lemasney","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+klEQVRIiWNgGAWjYBAC9mYwZQHj2ySAyAP4tPAcBlMSMH4aEVoOoGo5nEDQYTzszMce/GCQkNNtP/7swce283ny7Q2MBz7g08LMlm7YwyBhbHYmx9xwZtvtYoMzBxgOzsCjxZ6Zx0yCh0EicduBHDZp3rbbiRskEhgO8+C1hcdM8g+DRP2288+fSf9tO5c4f/4DhsN/CGiRBtqSYHYjwUyase1AYsMNYCDg9T4zW5q0jIGE4bYbb8wke84lJ244k9hwsAefFv7DxyTfVNjIm51Pfybxo8wucX774cMffuCzBgwMoDQjG5hsIKgBCeDz9igYBaNgFIxYAADJj0xxiDxmhQAAAABJRU5ErkJggg==","orcid":"","institution":"University College Dublin","correspondingAuthor":true,"prefix":"","firstName":"Fiona","middleName":"","lastName":"Lemasney","suffix":""},{"id":628955493,"identity":"0ef1a7ee-ae34-4a7d-bd52-79d189955703","order_by":2,"name":"Elizabeth Barrett","email":"","orcid":"","institution":"University College Dublin","correspondingAuthor":false,"prefix":"","firstName":"Elizabeth","middleName":"","lastName":"Barrett","suffix":""},{"id":628955494,"identity":"4cdeeccb-71f9-4068-b4f7-975c02b16b40","order_by":3,"name":"Peter Barrett","email":"","orcid":"","institution":"Health Service Executive","correspondingAuthor":false,"prefix":"","firstName":"Peter","middleName":"","lastName":"Barrett","suffix":""}],"badges":[],"createdAt":"2026-04-01 14:39:42","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9293333/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9293333/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107864990,"identity":"54f23104-550f-4b33-a847-8a60bb161fb9","added_by":"auto","created_at":"2026-04-27 06:29:25","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":100780,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePerceived Workplace Support for Breastfeeding Continuation (n and % rating \u0026lt;3).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePerceived Workplace Support for Breastfeeding Continuation, Percentage Rating \u0026lt;3 (Unsupportive).\u003c/strong\u003e \u0026nbsp;The figure shows perceived workplace support rated on a 0 – 4 scale.\u003c/p\u003e\n\u003cp\u003eRespondents rated nine workplace domains on a 0-4 scale (0 = Not at all supportive; 4 = Extremely supportive). Bars show the percentage rating each domain \u0026lt;3 (unsupportive: 0-2). Item-level denominators vary (n = 145-147, due to item-level missing data). Counts (n\u0026lt;3 / n; %) by domain, ordered highest to lowest unsupportive: \"Accessing HSE rights without self-advocacy\" (129/145; 88.97%; mean score 0.66); \"Sufficient time to express\" (130/147; 88.44%; 0.79); \"Reduced feelings of guilt/inconvenience\" (129/146; 88.36%; 0.77); \"On-call duties' impact\" (126/146; 86.30%; 0.88); \"Comfort expressing at work\" (125/146; 85.62%; 0.88); \"Comfort communicating with supervisor\" (124/147; 84.35%; 0.94); \"Career protection while breastfeeding\" (122/146; 83.56%; 0.95); \"Overall workplace support (formal and informal)\" (121/147; 82.31%; 0.99); \"Work culture \u0026amp; colleagues' attitudes\" (118/145; 81.38%; 1.21).\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9293333/v1/6287001c9b62eb6ef9102f48.jpg"},{"id":107865004,"identity":"51fdf3d7-b09a-497b-ab40-7efbdb8202b8","added_by":"auto","created_at":"2026-04-27 06:29:25","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":99328,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eMental-health and breastfeeding-related burden at return to work (Q16).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFigure 2.1: Proportion of respondents reporting moderate or severe mental health symptoms and/or breastfeeding- related complications.\u003c/p\u003e\n\u003cp\u003eFigure 2.2.: Mean severity scores (0-4 scale) for mental health symptoms and breastfeeding-related complications. 0 = none 4 = Severe\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMental-health and breastfeeding-related burden at return to work (Q16).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe figure shows survey responses to nine factors related to mental health and breastfeeding related burden on return to work rated on a 0 – 4 scale.\u003c/p\u003e\n\u003cp\u003eRespondents rated nine factors on a 0-4 scale (0 = Not at all, 4 = Severe). 2.1: Percentage rating moderate/severe (scores 3-4): \"Decreased sleep\" (62.91%; 95/151) and \"Difficulty expressing during extended work periods\" (52.98%; 80/151) were most frequent, followed by \"Breast engorgement\" (37.09%; 56/151), \"Burnout/work-related stress\" (29.80%; 45/151), \"General anxiety\" (28.29%; 43/152), \"Clogged ducts\" (23.03%; 35/152), \"Mastitis\" (13.16%; 20/152), \"PPD\" (7.95%; 12/151), and \"Breast abscess\" (1.99%; 3/151). 2.2: Mean severity (0-4) shows the same rank order: \"Sleep\" = 2.67; \"Expressing\" = 2.23; \"Engorgement\" = 1.81; \"Burnout\" = 1.64; \"Anxiety\" = 1.60; \"Clogged ducts\" = 1.16; \"Mastitis\" = 0.72; \"Postpartum depressive symptoms\" = 0.53; \"Abscess\" = 0.09. Item-specific n ≈ 151-152; percentages use per-item denominators.\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9293333/v1/6e6ff5ba3c314ffc17be1853.jpg"},{"id":108006433,"identity":"4209f713-2d76-494f-bda3-7c179ed32939","added_by":"auto","created_at":"2026-04-28 12:55:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":558986,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9293333/v1/dc6c9114-6cba-4942-ad0b-46d05c83a6e4.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Pumped for Policy: A Cross-Sectional Survey of Doctors within Ireland’s Public Health System on Breastfeeding Policy and Practice in the Medical Workforce","fulltext":[{"header":"Introduction","content":"\u003cp\u003eBreastfeeding is a foundational component of public health with well-established benefits for infants including enhanced immunity, cognitive development, bonding, and lower risk of later non-communicable disease as well as reduced maternal morbidity, conferring advantages of reduced postpartum hemorrhage and lower risks of breast and ovarian cancers (Health Service Executive \u0026amp; Association of Lactation Consultants in Ireland, 2016; World Health Organization, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Health Service Executive National Breastfeeding Implementation Group, 2024). The World Health Organization recommends exclusive breastfeeding for six months and continued breastfeeding to two years or beyond (WHO \u0026amp; United Nations Children's Fund, 2021). Despite the evidence supporting breastfeeding as a key moderator of infant and maternal health, Ireland's rates of breastfeeding initiation and continuation are amongst the lowest in the world (Health Service Executive, National Women and Infants Health Programme, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eImproving breastfeeding rates is recognised as a national public health priority in Ireland. This is indicated by government policy and investment designed to strengthen breastfeeding supports (Department of Health, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). The HSE Breastfeeding Action Plan, extended to 2025, is the national framework for advancing breastfeeding support in Ireland, which set a target of increasing breastfeeding rates by 2% annually. Breastfeeding policy is indicated as a priority in the Programme for Government 2025, which sets out a government-wide approach including funding for community initiatives, increasing lactation consultant provision in hospitals and communities, and supporting voluntary breastfeeding groups (Department of the Taoiseach, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2025\u003c/span\u003e, p. 64) alongside a separate commitment to invest in additional breastfeeding supports (Department of the Taoiseach, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2025\u003c/span\u003e, p. 88). National prevention frameworks also explicitly include breastfeeding as part of long-term child health and obesity prevention strategies (Department of Health, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Department of Health, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWorkplace policy is a key area to improve breastfeeding rates in Ireland and this is supported by governmental legislation, which has recently expanded workplace rights. Since July 2023, statutory paid breastfeeding breaks can now extend up to 104 weeks (2 years) postpartum (DoCEDIY, 2023). HSE policy protects lactation breaks and statutory leave. (HSE NBIG, 2020; HSE NBIG, 2024; WHO, 2022; Health Service Executive, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Paul et al. \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). However, qualitative Irish evidence suggests workplace breastfeeding remains culturally constrained, with women reporting stigma, inconsistent advice, and concealment of breastfeeding at work due to embarrassment and perceived lack of employer support. This highlights deficits in implementation rather than policy as a fundamental factor in continued low rates of breastfeeding (HSE NBIG, 2024; World Breastfeeding Trends Initiative Ireland Core Group, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) (Desmond \u0026amp; Meaney, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2016\u003c/span\u003e.)\u003c/p\u003e \u003cp\u003eThere has been a notable lack of research evaluating how clinician mothers in Ireland experience breastfeeding in the workplace and how workplace conditions align with national policy and statutory entitlements, within HSE settings (Desmond \u0026amp; Meaney, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; HSE NBIG, 2020; HSE NBIG, 2024; HSE NDTP, 2024). To our knowledge, no national study has explored the return-to-work breastfeeding journeys of Irish physicians, creating a significant gap in both academic literature, policy development, and resourcing of effective supports (HSE, 2016; French et al. \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). This can also make it harder to continue breastfeeding after return to work, despite breastfeeding being a stated national public health priority in Ireland. (DoH, 2024; HSE NBIG, 2024). We therefore examine breastfeeding continuation after return to work among Irish physicians by assessing workplace accommodations and policy awareness, and measuring feeding outcomes at return.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eA voluntary, mixed-methods survey was administered on SurveyMonkey (encrypted, industry-standard security) incorporating both quantitative and qualitative questions. Ethics exemption was granted by University College Dublin (UCD); participants provided informed consent.\u003c/p\u003e \u003cp\u003eSurvey was piloted twice and opportunistic sampling was used. Recruitment occurred via the \"Doctors as Parents\" Facebook group, the Forum of Irish Postgraduate Medical Training Bodies, the Women in Medicine in Ireland Network (WiMIN), LinkedIn, and X (Twitter). Data collection ran from July 4 to July 18, 2025. The questionnaire drew on prior instruments (Frolkis et al. \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Kevric et al. \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Sattari et al. \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) examining similar populations and incorporated HSE Breastfeeding Policy for Staff language into operational items (HSE NBIG, 2020), standardizing response scales (Likert 0\u0026ndash;4; Yes/No; multi-select) and removing duplicates identified during the two pilot rounds.\u003c/p\u003e \u003cp\u003eQuantitative analyses were performed in Excel and Python (two-sided tests). Descriptive statistics were computed for breastfeeding initiation, duration, complications, and perceived workplace support scores.\u003c/p\u003e \u003cp\u003eEligibility targeted physicians in Ireland who had breastfed and returned to work. The survey covered five domains: (1) demographics (specialty, role, number of children); (2) breastfeeding practices (breastfeeding initiation, duration, intentions/goals, complications); (3) workplace accommodations (e.g., lactation rooms, protected breaks, storage options, scheduling flexibility); (4) policy awareness (e.g., HSE Breastfeeding Policy); and (5) cultural attitudes (perceived support from supervisors and peers). Items were a mix of closed-ended (Likert; Yes/No) and open-ended questions.\u003c/p\u003e \u003cp\u003eAwareness of the existence of the HR117 process in the policy was scored 0\u0026thinsp;=\u0026thinsp;Not aware, 1\u0026thinsp;=\u0026thinsp;Partially aware, 2\u0026thinsp;=\u0026thinsp;Fully aware; the main comparison contrasted no awareness (n\u0026thinsp;=\u0026thinsp;86) with any awareness (n\u0026thinsp;=\u0026thinsp;66). The HR117 process refers to a documented HR pathway that includes a standard form and a defined procedure to notify return-to-work, and to formally arrange lactation breaks, a private space and milk storage, with an identified contact person and written confirmation of the arrangement. Availability of 16 HSE policy-aligned supports (e.g., paid breaks, flexible scheduling, lactation rooms, facilities, training, HR117 process, review of arrangements, cooler bags/ice packs) was rated 0\u0026thinsp;=\u0026thinsp;No, 1\u0026thinsp;=\u0026thinsp;In part, 2\u0026thinsp;=\u0026thinsp;Yes. Analyses used per-item denominators; \"Don't know/not applicable\" and blanks were excluded.\u003c/p\u003e \u003cp\u003ePerceived workplace support was assessed across nine domains (e.g., work culture, time to express, supervisor communication, on-call duties, career protection, access to HSE Breastfeeding Policy rights). Access to rights' assessed awareness of statutory/HSE entitlements, clarity of the access pathway (HR117), and the ability to take protected breaks and use appropriate facilities without adverse consequences. Each was rated on a 0\u0026ndash;4 Likert scale, with analyses reporting mean scores and the proportion rating\u0026thinsp;\u0026lt;\u0026thinsp;3 (unsupportive; \u0026lt;3\u0026thinsp;=\u0026thinsp;scores 0\u0026ndash;2). Item-level denominators varied due to missing data.\u003c/p\u003e \u003cp\u003eBreastfeeding complications items from Q16 (e.g., engorgement, clogged ducts, mastitis, abscess, difficulty expressing during extended work) were rated 0\u0026ndash;4 severity (0\u0026thinsp;=\u0026thinsp;None; 4\u0026thinsp;=\u0026thinsp;Severe). For each complication, we report the mean severity score and the proportion classified as moderate-severe (scores 3\u0026ndash;4).\u003c/p\u003e \u003cp\u003eAssociations between policy awareness and availability of supports (0\u0026ndash;2 items) were tested using Chi-square (χ\u0026sup2; ) with Cramer's V and Mann-Whitney U. For Mann-Whitney U, awareness was grouped 0 vs 1\u0026ndash;2. χ\u0026sup2; used 3\u0026times;3 contingency tables (awareness 0/1/2 \u0026times; availability 0/1/2; df\u0026thinsp;=\u0026thinsp;4). Spearman's rank correlation examined workplace supportiveness (0\u0026ndash;4 domains) and breastfeeding continuation after return to work. Changes in exclusive breastfeeding from birth to return to work were assessed with McNemar's test (paired binary), two-sided. Our primary return-to-work outcome was human-milk only (no formula); we also repeated the analysis using a stricter WHO definition (no solids or formula).\u003c/p\u003e \u003cp\u003eBreastfeeding continuation at return to work was defined from the Q13 item 'Were you breastfeeding when you returned to work after your most recent childbirth?' (Yes\u0026thinsp;=\u0026thinsp;1, No\u0026thinsp;=\u0026thinsp;0). Analyses used per-item denominators; 'Don't know/not applicable' and blanks were excluded.\u003c/p\u003e \u003cp\u003eAll tests were two-sided with α\u0026thinsp;=\u0026thinsp;0.05; p-values are unadjusted for multiple comparisons given the exploratory aims, and exact values are reported (when p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, we report 'p\u0026thinsp;\u0026lt;\u0026thinsp;0.001' rather than a rounded value).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eAt return to work, 85.53% (130/152) were breastfeeding; human-milk only (no formula) at return was 15.79% (24/152). Comparing respondents with no awareness of HSE breastfeeding policies (score = 0; n = 86) to those with partial or full awareness (scores = 1-2; n = 66), all 16 policy-aligned items showed higher reported availability among those with awareness (Mann-Whitney U: p \u0026lt;0.001 for most; \u0026quot;Regular review\u0026quot; p = 0.002; and \u0026quot;Cooler bags/ice packs\u0026quot; p = 0.008). Chi-square (\u0026chi;\u0026sup2;) tests on 3\u0026times;3 tables showed consistent results, with moderate associations for key items: \u0026quot;Access to training/resources\u0026quot; (\u0026chi;\u0026sup2; = 72.65, V = 0.49); \u0026quot;Opportunity to negotiate breaks\u0026quot; (\u0026chi;\u0026sup2; = 68.46, V = 0.47); and \u0026quot;Information on expression/storage\u0026quot; (\u0026chi;\u0026sup2; = 54.38, V = 0.42) [Insert Table 1 here].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBreastfeeding continuation after return to work was positively correlated with several workplace support factors: \u0026quot;Career protection\u0026quot; (\u0026rho; = 0.24, p = 0.003); \u0026quot;Reduced on-call impact\u0026quot; (\u0026rho; = 0.23, p = 0.005); \u0026quot;Comfort expressing at work\u0026quot; (\u0026rho; = 0.22, p = 0.009); \u0026quot;Overall workplace support\u0026quot; (\u0026rho; = 0.22, p = 0.009); \u0026quot;Reduced guilt/inconvenience\u0026quot; (\u0026rho; = 0.21, p = 0.011); \u0026quot;Sufficient time to express\u0026quot; (\u0026rho; = 0.20, p = 0.013); \u0026quot;Assistance accessing rights\u0026quot; (\u0026rho; = 0.20, p = 0.016); \u0026quot;Comfort communicating with supervisors\u0026quot; (\u0026rho; = 0.17, p = 0.038); and \u0026quot;Work culture \u0026amp; colleague attitudes\u0026quot; (\u0026rho; = 0.17, p = 0.047) [Insert Table 2 here].\u003c/p\u003e\n\u003cp\u003ePerceived workplace support (0-4) was rated poorly across all nine domains, with mean scores ranging from 0.66 to 1.21. Most respondents rated each domain as unsupportive (\u0026lt;3), with proportions exceeding 80% in all areas. The lowest-rated domain was for \u0026quot;Support in accessing HSE rights without self-advocacy\u0026quot; with 88.97% (129/145; mean = 0.66) of respondents rating it unsupportive, followed by \u0026quot;Sufficient time during work hours to express\u0026quot; with 88.44% (130/147; mean = 0.79). Even the most positively rated domain, \u0026quot;Work culture \u0026amp; colleague attitudes,\u0026quot; still received a mean of only 1.21, with 81.38% rating it unsupportive (118/145) [Insert Figure 1 here]. Denominators varied slightly across domains due to item non-response (range: n = 145-147). Overall, fewer than one in five respondents rated any workplace support domain as adequate (\u0026ge;3), underscoring widespread deficits.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWork-related breastfeeding complications were frequently reported: Moderate/severe burden (scores 3-4; item specific denominators on 0-4 scale) was highest for \u0026quot;Decreased sleep\u0026quot; with 62.91% (95/151, mean 2.67) and \u0026quot;Difficulty expressing due to extended work periods\u0026quot; with 52.98% (80/151, mean 2.23), followed by \u0026quot;Breast engorgement\u0026quot; with 37.09% (56/151, mean 1.81). Psychological strain was common but typically less intense: \u0026quot;Burnout/work stress\u0026quot; = 29.80% (45/151, mean 1.64) and \u0026quot;General anxiety\u0026quot; = 28.29% (43/152, mean 1.60). Clinical complications were less frequently rated as moderate/severe: \u0026quot;Clogged ducts\u0026quot; = 23.03% (35/152, mean 1.16), \u0026quot;Mastitis\u0026quot; = 13.16% (20/152, mean 0.72), \u0026quot;Postpartum depressive symptoms\u0026quot; = 7.95% (12/151, mean 0.53), and \u0026quot;Breast abscess\u0026quot; = 1.99% (3/151, mean 0.09). Many respondents linked complications to missed or delayed feeds during work, consistent with occupational risk for physician mothers [Insert Figure 2.1 and 2.2 here].\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study is the first to examine breastfeeding practices among physicians in Ireland. Exclusive breastfeeding (EBF) at birth was high (86.18%, 131/152)\u003csub\u003e\u0026minus;\u003c/sub\u003eafter return to work, most participants were still breastfeeding (85.53%, 130/152), yet only 15.79% (24/152) reported providing human-milk only (no formula), indicating a substantial shift towards formula/mixed feeding on return to work (McNemar χ\u0026sup2;=106.01, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Using a stricter WHO definition at return (no solids or formula), the estimate was 7.89% (12/152) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eBecause most returns occur at \u0026ge;\u0026thinsp;6 months in Ireland when complementary foods are typically introduced, we treat human-milk only (no formula) at return as the outcome that best reflects the impact of workplace supports (time, space, storage). This framing aligns with Irish prevention policy, which positions breastfeeding as a long-term child-health measure, including prevention of childhood infectious disease and obesity (DoH, 2013; DoH, 2016).\u003c/p\u003e \u003cp\u003eThese findings are especially salient in the current Irish context: Ireland's WBTi assessment describes a moderate policy/programme framework, yet breastfeeding practice indicators remain poor, suggesting an implementation gap rather than policy absence (WBTiICG, 2023).\u003c/p\u003e \u003cp\u003eNational indicators remain low (32% exclusive breastfeeding at three months) (HSE NBIG, 2024), and routine surveillance beyond ~\u0026thinsp;3 months postpartum is limited, restricting evaluation of interventions and identification of subgroups requiring additional support (WBTiICG, 2023). Although national breastfeeding supports, training initiatives, and workplace entitlements have expanded (including extension of statutory workplace breastfeeding breaks to two years postpartum), translation into day-to-day practice in high-intensity clinical settings may be inconsistent (HSE NBIG, 2024; DoCEDIY, 2023).\u003c/p\u003e \u003cp\u003eWorkplace stigma, inconsistent support and unclear enforcement of rights, are especially relevant upon return to work, and can disrupt feeding plans and increase mental health strain (Desmond \u0026amp; Meaney, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; French et al. \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Frolkis et al. \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Vilar-Compte et al. \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Knutson \u0026amp; Butler, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). At a systems level, paid, protected expressing breaks of six months or longer are associated with higher exclusive breastfeeding (\u0026asymp;\u0026thinsp;8.9 percentage-point increase), underscoring the role of concrete workplace policy in supporting breastfeeding and the downstream long-term health benefits for mothers and children (Heymann et al. \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2013\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOur results mirror international physician data linking re-entry to early cessation when protected time and private space are scarce (Frolkis et al. \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Kevric et al. \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Riggins et al. \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Sattari et al. \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). In our sample, 19.08% (29/152) reported not meeting a breastfeeding goal for at least one child. At the same time, 62.50% breastfed beyond one year and 23.03% beyond two; impressive in an Irish context whereby breastfeeding\u0026thinsp;\u0026gt;\u0026thinsp;1 year is far from the norm, suggesting strong motivation amid persistent systemic barriers (Paul et al. \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; WHO, 2022). Taken together, strong overall breastfeeding duration alongside a sharp drop in milk-only feeding upon return to work supports a structural/workplace constraint interpretation, rather than a lack of motivation (WBTiICG, 2023), occurring in a context of heightened burnout risk among women clinicians (Eischen et al. \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Haffizulla et al. \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Lyubarova et al. \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eContinuation after return to work also appeared sensitive to workplace conditions across children; among respondents with more than one child (n\u0026thinsp;=\u0026thinsp;119), 36.13% (43/119) reported that workplace factors moderately or strongly influenced how breastfeeding went across children, whereas 42.86% (51/119) reported no effect. This pattern suggests differences by site, rota, and supervisor, and is also seen in North American and Australasian cohorts arguing for standardized, default processes over self-negotiation (Castillo-Angeles et al. \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; French et al. \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Frolkis et al. \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Kevric et al. \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Sattari et al. \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). This is particularly important for trainees who face the greatest power asymmetries (Haffizulla et al. \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Lyubarova et al. \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePerceived workplace support across nine domains was uniformly low (means 0.66\u0026ndash;1.21/4), with fewer than 20% of participants rating any domain as supportive (\u0026ge;\u0026thinsp;3). The worst-rated areas, which were \"Support in accessing HSE rights without self-advocacy\" (88.97% unsupportive; 11.03% supportive [\u0026ge;\u0026thinsp;3]) and \"Sufficient time during work hours to express\" (88.44% unsupportive; 11.56% supportive), map directly to the day-to-day policy implementation gaps in clinical work, that intensify stress and elevate mental-health risk (HSE NBIG, 2020; Vilar-Compte et al. \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Fantasia, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Sattari et al. \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Bye et al. \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). In practical terms, this mismatch implies that having policy, funding, and statutory rights in place does not reliably translate into predictable time, space, storage, and managerial support for doctors on the ground (HSE NBIG, 2024; DoCEDIY, 2023; DoH, 2024).\u003c/p\u003e \u003cp\u003eConsistent with prior physician literature, awareness of HSE policy rights coincided with greater availability of concrete supports across all 16 items (Mann-Whitney U: p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 predominantly; parallel χ\u0026sup2; tests showed moderate associations), indicating that policy knowledge and implementation tend to co-occur (Fantasia, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Knutson \u0026amp; Butler, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Tomori, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Continuation also correlated modestly but consistently (ρ\u0026thinsp;=\u0026thinsp;0.17\u0026ndash;0.24) with career protection, reduced on-call impact, comfort expressing, time/space to express, supervisor communication, overall support, assistance accessing rights, and team culture. These domains map to modifiable determinants repeatedly observed among physicians: fear of career penalty, scheduling rigidity, and stigma around requesting breaks or space (Caperelli Gergel \u0026amp; Terry, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Castillo-Angeles et al. \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; French et al. \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Sattari et al. \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Tomori, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Vilar-Compte et al. \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eReported complications including engorgement, difficulty expressing due to extended work periods, clogged ducts, mastitis, and breast abscess, are consistent with infrequent milk removal under workload pressure. These harms jeopardise maternal health and service continuity and hasten weaning, undermining the benefits underpinning WHO recommendations (HSE \u0026amp; ALCI, 2016; Tomori, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; WHO, 2022). Equity concerns arise when access hinges on self-advocacy, disadvantaging earlier trainees or less supported teams (Knutson \u0026amp; Butler, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Vilar-Compte et al. \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAmong those returning to work when infants were 6\u0026ndash;12 months old, majority (92.86%) were non-exclusive, most of whom were partially breastfeeding, with EBF being 7.14% (8/112), which likely reflects both complementary feeding by ~\u0026thinsp;6 months and workplace constraints that make exclusivity harder to sustain. Policy implications are therefore implementation-first: protected expressing time, predictable cross-cover on rounds/procedures, private/lockable spaces with sanitation and cold storage, and manager training to normalize rights and reduce stigma. Prioritizing assistance in accessing rights without self-advocacy and time to express should be central to HSE updates, given their strong deficits.\u003c/p\u003e \u003cp\u003eBreastfeeding outcomes after return to work are strongly influenced by how well workplaces support lactation, with downstream implications for gender equity and workforce retention (Haffizulla et al. \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Lyubarova et al. \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Sarma et al. \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Within medicine, women physicians face distinct burnout pressures related to workload, recognition of value and perceived worth, and work-family conflicts. This is particularly important in Ireland given the gender profile of Irish doctors. Female trainees are in the majority (53% Intern, 57% Basic Specialist Training, 54% Higher Specialist Training; 55% total) in contrast to a male-majority consultant cohort (41% female). (Health Service Executive, 2024) Poor lactation accommodation at re-entry risks disrupting women's return and progression while amplifying stress, sleep loss, anxiety and PPD (Eischen et al. \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Haffizulla et al. \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Hoang Roberts et al. \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; HSE NDTP, 2024; Lyubarova et al. \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Sattari et al. \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). It is established that increasing workplace supports, such as ensuring protected time and space to express, facilitates women to sustain breastfeeding, reduces the risk of gendered burnout and related mental health consequences, thus supporting retention. (Fantasia, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; French et al. \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Haffizulla et al. \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Lyubarova et al. \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Sarma et al. \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Tomori, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Vilar-Compte et al. \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). In this context, workplace lactation support is not simply an individual \"accommodation,\" but a basic workplace condition that can shape gender equity, influencing training progression, retention, and the sustainability of the medical workforce.\u003c/p\u003e \u003cp\u003eAs it is a primary, exploratory study, utilizing cross-sectional and self-reported data as well as possible self-selection, causal interference and generalizability is limited. The high rates of EBF observed in our sample may not be representative or generalizable to a wider sample due to the opt-in bias introduced by opportunistic sampling. Also, planned subgroup analyses by career stage and specialty were not pursued because group sizes were small and estimates imprecise; any comparisons are presented descriptively only. However, convergence across awareness, availability, support, complications, and continuation strengthens internal consistency.\u003c/p\u003e \u003cp\u003eFuture research should combine quantitative and qualitative methods in larger, more diverse samples, and evaluate the impact of targeted interventions, particularly within training programs, on breastfeeding outcomes. Larger samples are needed to test differences by career stage and specialty. Given national gaps in post-discharge surveillance, future evaluations should include standardized measurement of infant feeding outcomes beyond 3 months postpartum where feasible, alongside implementation measures (availability, accessibility, and usability of supports) and workforce outcomes (absence, intention to stay, retention) (WBTiICG, 2023).\u003c/p\u003e \u003cp\u003eIn practical terms, our data point to real-world fixes; rostered, protected breaks to express with predictable cross-cover, private lockable spaces with sanitation and cold storage, and proactive manager/HR processes, to sustain breastfeeding at work without compromising patient care.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cu\u003eHuman Ethics and Consent to Participate\u003c/u\u003e\u003cu\u003e:\u0026nbsp;\u003c/u\u003eThe authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committee on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008. The authors assert that the local ethics committee has determined that ethical approval for publication of this\u0026nbsp;original research has been provided by their local Ethics Committee; Ref. No.: UTMREC- SM-E-25-631-Mah-Barrett. Informed consent to participate in the study was obtained from all participants\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eConsent for publication:\u003c/u\u003e not applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eAvailability of data and materials:\u003c/u\u003eThe datasets generated and/or analysed during the current study are not publicly available due to privacy concerns for the survey participants but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eFunding Declaration:\u003c/u\u003e This research received no specific grant from any funding agency, commercial or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eCompeting Interests:\u003c/u\u003e The author(s) declare none.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eAuthors' contributions\u003c/u\u003e This study was conceptualized and designed by Dr. Elizabeth Barrett and Dr. Fiona Lemasney, building on previous literature reviews and work with expert by experience groups. Jian Mae Mah, Dr. Fiona Lemasney and Dr. Elizabeth Barrett contributed to survey development and piloting and dissemination. The first author Jian Mae Mah performed all quantitative analyses, created all figures and tables (adapted from SurveyMonkey outputs where applicable), and produced the first manuscript draft in collaboration with Dr. Lemasney. Dr Peter Barrett reviewed the paper and provided comments and suggested amendments. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eAcknowledgement:\u003c/u\u003e The author wishes to acknowledge the “Doctors as Parents” Facebook Group, Dr. Sarah Fitzgibbon of Women in Medicine in Ireland Network, Dr. Sarah Brennan from the University ofGalway, and Jack O’Flanagan from the Forum of Irish Postgraduate Medical Training Bodies, for their help in promoting the survey, as well as the UCD SSRA Office for this project opportunity.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003e\u003cstrong\u003eBye E, Leval R, Sayles H, Doyle M, Mathes M, Cudzilo-Kelsey L \u003c/strong\u003e(2022). Parental postpartum depression among medical residents. \u003cem\u003eArchives of Women\u0026apos;s Mental Health\u003c/em\u003e \u003cstrong\u003e25\u003c/strong\u003e, 1129-1135. (https://doi.org/10.1007/s00737-022-01271-3). 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(https://doi.org/10.1016/j.bpobgyn.2022.01.010). Accessed 15 August 2025.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eVilar-Compte M, Hern\u0026aacute;ndez-Cordero S, Ancira-Moreno M, Burrola-M\u0026eacute;ndez S, Ferre-Eguiluz I, Oma\u0026ntilde;a I, P\u0026eacute;rez Navarro C \u003c/strong\u003e(2021). Breastfeeding at the workplace: a systematic review of interventions to improve workplace environments to facilitate breastfeeding among working women. \u003cem\u003eInternational Journal for Equity in Health\u003c/em\u003e \u003cstrong\u003e20\u003c/strong\u003e, 110. (https://doi.org/10.1186/s12939-021-01432-3). Accessed 15 August 2025.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eWorld Breastfeeding Trends Initiative Ireland Core Group\u003c/strong\u003e (2023). \u003cem\u003eAssessment Report: Ireland 2023.\u003c/em\u003e (https://www.worldbreastfeedingtrends.org/uploads/country-data/country-report/WBTi-Ireland-2023.pdf). Accessed 29 January 2026.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eWorld Health Organization, United Nations Children\u0026apos;s Fund\u003c/strong\u003e (2021\u003cem\u003e). Global Breastfeeding Scorecard 2021: protecting breastfeeding through bold national actions during the COVID-19 pandemic and beyond.\u003c/em\u003e Geneva: World Health Organization. (https://iris.who.int/bitstream/handle/10665/348546/WHO-HEP-NFS-21.45-eng.pdf?sequence=1). Accessed 15 August 2025.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eWorld Health Organization \u003c/strong\u003e(2022). \u003cem\u003eInfant and young child feeding\u003c/em\u003e. Geneva: World Health Organization. (https://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding). Accessed 15 August 2025.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Table 1","content":"\u003cp\u003e\u003cstrong\u003eTable 1. Comparison of Workplace Breastfeeding Supports by Policy Awareness.\u003c/strong\u003e Scores range from 0 = No, 1 = In part, 2 = Yes. Group comparisons were made between participants with no awareness of their rights (score = 0; n = 86) and those with partial or full awareness (score = 1 or 2; n = 66). Mann-Whitney U tests compare the distribution of scores between groups (U = test statistic). For categorical comparisons: χ² tests used 3×3 contingency tables (awareness 0/1/2 × availability 0/1/2; df = 4) and Cramer's V = effect size (0 = No association, 1 = Perfect association). Higher mean scores indicate greater reported access to the workplace breastfeeding support item.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFor the Mann-Whitney U test, p-values were \u0026lt;0.001 for 14/16 items, except: \"Regular review of breastfeeding arrangements (e.g., after 1 month, then quarterly)\" (p = 0.002) and \"Access to cooler bags and ice packs for milk transport\" (p = 0.008). For the χ² tests, p-values were \u0026lt;0.001 except: \"Regular review of breastfeeding arrangements (e.g., after 1 month, then quarterly)\" (p = 0.002) and \"Access to cooler bags and ice packs for milk transport\" (p = 0.005). Bold rows highlight items with higher p-values but still statistically significant at p \u0026lt;0.05.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHSE Policy Support Item\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean Score (No Awareness)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean (Partial/Full Awareness)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eU Statistic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eχ² value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCramer's V\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOpportunity to discuss and negotiate how breastfeeding breaks would be taken\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1212.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e68.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAccess to training or resources related to breastfeeding policy and rights\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1575.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e72.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePaid breastfeeding breaks (up to 1 hour per day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1563.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e42.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFlexibility in how breaks were taken (e.g., 60 min, 2×30 min, or 3×20 min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1585.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e42.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSupport from line manager to facilitate breastfeeding breaks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1707.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e45.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.39\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAvailability of information on expressing and storing breast milk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1912.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e54.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAccess to handwashing facilities and a chair in the lactation space\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1725.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e40.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAccess to private, lockable, hygienic, comfortable, and appropriately equipped lactation room (not a toilet)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1726.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e40.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAvailability of information on how to store, transport, and safely use expressed milk at home\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1964.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e52.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eManagerial support in arranging breastfeeding breaks and facilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1853.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e44.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAccess to a fridge to store expressed breast milk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1754.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e29.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eAbility to apply using HR117 form at least 4 weeks before return to work\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2085.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e25.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eEncouragement to maintain breastfeeding upon return to work\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2022.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e30.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOption to reduce the working day by 1 hour (if no suitable space available)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2100.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e21.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eRegular review of breastfeeding arrangements (e.g., after 1 month, then quarterly)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.02\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.18\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e2487.00\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e16.89\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.24\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAccess to cooler bags and ice packs for milk transport\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.08\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.32\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e2437.00\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e14.77\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.22\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Correlation Between Workplace Supportiveness and Continued Breastfeeding at Work.\u003c/strong\u003e This table shows the association between perceived workplace supportiveness and rates of continued breastfeeding among participants.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSpearman’s rank correlation (p) between perceived workplace supportiveness and continuation of breastfeeding upon return to work.\u003c/strong\u003e Spearman's ρ = Spearman rank correlation coefficient, measuring the association between perceived workplace support (0-4; 0 = Not at all supportive, 4 = Extremely supportive; item-level n shown) and continuation of breastfeeding after return to work (Yes = 1, No = 0). Positive values indicate that higher perceived support is associated with a greater likelihood of continuing breastfeeding. All reported correlations were statistically significant at p \u0026lt;0.05; 4 of 9 were p\u0026lt;0.01 (\"career protection\", \"on-call impact\", \"comfort expressing\", and \"overall support\"). Exact p-values are reported for each domain.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"630\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWorkplace Support Item\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSpearman's ρ\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSupportive environment that protected career progression while breastfeeding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e146\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eImpact of on-call duties on your ability to breastfeed or express milk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e146\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eWorkplace support in helping you feel comfortable expressing during work hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e146\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSupport from workplace (formal policies and informal support)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e147\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eWorkplace support in reducing feelings of guilt or inconvenience when breastfeeding or expressing at work\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e146\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSufficient time during work hours to express milk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e147\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eSupport from workplace in helping you access your HSE breastfeeding rights without needing self-advocacy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e145\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eComfort communicating breastfeeding needs with supervisor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.038\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e147\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eWork culture \u0026amp; colleague attitudes regarding breastfeeding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.047\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e145\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Breastfeeding, physician mothers, breastfeeding self-efficacy, workplace support, Healthcare workforce","lastPublishedDoi":"10.21203/rs.3.rs-9293333/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9293333/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePhysician mothers face unique barriers to breastfeeding despite clinical knowledge of its benefits, including inflexible schedules, limited lactation support, and cultural biases. Despite the many maternal and infant benefits, structural workplace barriers often cause early cessation, especially after returning to clinical duties. These challenges contribute to reduced maternal satisfaction and professional dissatisfaction. This study explores the breastfeeding experiences of physicians in Ireland and assesses whether workplace policies meet their needs.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA national, cross-sectional mixed-methods survey was developed, adapted from validated international tools. It captured responses across specialities, including consultants (32.89%) and general practitioners (13.82%). Statistical analyses included Chi-square, Mann\u0026ndash;Whitney U, McNemar, and Spearman\u0026rsquo;s rank tests.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eFindings highlight a persistent gap between the Health Service Executive (HSE) Breastfeeding Policy for Staff and clinical workplace realities. While initiation was high with 86.18% (n\u0026thinsp;=\u0026thinsp;131), continuation at work was far lower, with only 30.26% (46) breastfeeding or expressing during clinical hours. Few felt adequately supported: 21.05% (32) rated lactation spaces as supportive, and 23.68% (36) reported feeling well-informed about their entitlements. Although 14.47% (22) said flexible break options were available, ratings across all policy supports remained uniformly low, with fewer than one in five respondents finding any domain supportive.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThese results underscore how insufficient facilities, limited time, and cultural stigma continue to undermine breastfeeding goals among healthcare professionals. These findings suggest a need for systemic reform to ensure that stated HSE policies result in tangible workplace improvements.\u003c/p\u003e","manuscriptTitle":"Pumped for Policy: A Cross-Sectional Survey of Doctors within Ireland’s Public Health System on Breastfeeding Policy and Practice in the Medical Workforce","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-27 06:29:06","doi":"10.21203/rs.3.rs-9293333/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-12T06:15:22+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"103293432632006595689289392680143533440","date":"2026-05-11T18:49:24+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-11T17:24:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"333150552244346035118017941564631996573","date":"2026-05-11T16:39:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"12002885587474822060835035136340132677","date":"2026-05-11T15:26:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"100071202479824395909742760224083097811","date":"2026-05-11T07:54:49+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-11T06:30:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"247437455739294073357147521931583736104","date":"2026-05-11T04:53:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"65905626730731793272537398091317783422","date":"2026-04-19T00:50:15+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-18T13:08:01+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-15T11:55:20+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-14T12:56:43+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-14T12:56:31+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2026-04-01T14:31:29+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"15bddf30-ea0f-4f71-8e17-fd9cce7b9cd8","owner":[],"postedDate":"April 27th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-12T06:15:22+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"103293432632006595689289392680143533440","date":"2026-05-11T18:49:24+00:00","index":184,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-11T17:24:07+00:00","index":183,"fulltext":""},{"type":"reviewerAgreed","content":"333150552244346035118017941564631996573","date":"2026-05-11T16:39:26+00:00","index":182,"fulltext":""},{"type":"reviewerAgreed","content":"12002885587474822060835035136340132677","date":"2026-05-11T15:26:20+00:00","index":181,"fulltext":""},{"type":"reviewerAgreed","content":"100071202479824395909742760224083097811","date":"2026-05-11T07:54:49+00:00","index":178,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-11T06:30:44+00:00","index":177,"fulltext":""},{"type":"reviewerAgreed","content":"247437455739294073357147521931583736104","date":"2026-05-11T04:53:31+00:00","index":176,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-05-12T06:26:19+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-27 06:29:06","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9293333","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9293333","identity":"rs-9293333","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}