You may remember the cover of Time magazine from several years ago, in which a slim, pretty blond mother was nursing her three year old while he stood on a stool. The photo was clearly staged to be provocative, but the ensuing outcry made it clear that breastfeeding toddlers is quite a taboo subject here in the U.S. (and increasingly throughout the world). However, the American Academy of Pediatrics recommends that breastfeeding continue for at least 12 months—and as long as “mutually desired by mother and child.” As long as breastfeeding continues, both parties experience important nutritional, immune, and other health benefits. In fact, some anthropological studies have suggested that humans evolved to breastfeed for two and a half to seven years.

Extended breastfeeding, defined as breastfeeding longer than 12 months, can be a challenge for working women. For women in Emergency Medicine, the unpredictable schedule adds another layer of complexity. To learn more about whether women who continued to breastfeed beyond the conventional 12 months faced any pressure from their co-workers or employers to stop pumping, what motivated them to continue breastfeeding, and what other challenges they faced, I conducted an informal survey on the Physician Moms Group on Facebook.  Women from a wide variety of specialties responded.

A strong majority felt their employer supported breastfeeding and pumping when their children were less than 12 months old. Almost 90 percent of respondents felt that way.  In fact, Kristin Cowperthwaite, an Emergency Medicine doctor, said that her medical director cleared out his office to allow her space to pump. Now in a new work environment, she uses Freemie cups and pumps at her workstation in the ED. “I’ve decided that there is nothing to be embarrassed about. Just like there’s nothing to be embarrassed about breastfeeding in public,” she said. “If you just own it, no one will care. So I’m owning it, even if it’s not what people are used to.”

Many women stopped pumping at work sometime between 10 and 15 months. For those who continued, encouragement for breastfeeding decreased substantially. Despite recommendations by AAP, AAFP, and WHO, about one-third of respondents did not feel supported after 12 months. Women expressed a variety of challenges, but recurring themes were societal pressure to stop and finding time within shifts to pump. Several mothers noted that their husbands and other family members wanted them to stop. Some faced the societal expectations of those who asked, “You’re still doing that?” One mom said, “After 12 months, others viewed breastfeeding as ‘no longer needed.’ I had no support so I completely quit pumping at work and just fed at home.”

Women who breastfed for a long time were motivated by a wide variety of factors. Some felt that they needed to because formula was too expensive, some had really persistent children who didn’t want to give it up, and of course, some really enjoyed the experience and the closeness they shared with their children.

They had a lot of strategies they used to continue breastfeeding—each of which could  help any woman who wants to pump at work.

1. Try to get a computer where you pump so you can chart while pumping.
2. Seek out hands-free pumping options, like Freemie cups or a Simple Wishes pumping bra.
3. Pump while driving—if it’s not too distracting.
4. Breastfeed at home if the work environment isn’t as conducive.
5. Share a bed with your child and nurse at night.
6. Team up with other breastfeeding employees and cover for each other when needed.
7. Pump before and after work if you are unable to get away as often as you’d like during shifts

As with most issues facing women in the workplace, there’s not a one-size-fits-all answer for how to feed your child, but the ability to choose is of paramount importance. Hopefully, with the experiences of these women in mind, those who do wish to breastfeed beyond 12 months will feel prepared and supported in doing so.