A surgeon from Granada, Spain, has won a first-instance lawsuit against the National Social Security Institute (INSS), the Andalusian Health Service, and the General Treasury of the Social Security, which recognized her right to receive the risk allowance during breastfeeding. The court ruled that her work at the hospital — including long on-call shifts, night shifts, and exposure to biological and chemical agents — makes safe and realistic breastfeeding impossible, and therefore the benefit should have been granted.

Alejandro Valdés Pérez, a lawyer with the Legal Advisory Office of the Granada Medical Union and the surgeon’s attorney, explained to El Médico Interactivo, part of Medscape’s Professional network, the significance of this ruling for all female doctors in Spain. “It is significant because it aligns with the Supreme Court’s recent doctrine, making it clear that it is not sufficient to simply state that ‘there is no risk’ without further justification.” The ruling essentially states that risks during breastfeeding must be studied in detail, and the issuance of generic reports must not be allowed to harm female physicians. An administrative decision that merely denies the benefit without further assessment or justification specific to the individual case may be discriminatory. It requires the administration to seriously evaluate the position and its conditions, placing the debate within the context of fundamental rights protection. The attorney notes that the union is receiving more cases similar to this surgeon’s. “The problem is that many female doctors end up accepting this as normal, and the situation goes unreported — either because they adapt as best they can, because they reduce breastfeeding, or simply because they give it up altogether,” he stated.

‘It’s a Matter of Correctly Applying the Regulations’

Valdés Pérez confirms that there is a problem with work organization but also with how risks are assessed. In the vast majority of cases, generic reports are produced that do not reflect the actual job, and that ends up affecting all subsequent decisions. There is also a lack of effective and practical solutions as people always resort to the catch-all option of on-site breast pumping to try to neutralize or mitigate the risk, but the truth is that, in cases like this, it’s more of a theoretical option than a realistic one due to the conditions and difficulties of the job. Finally, there is also a lack of coordination in these cases among government agencies — that is, regional health services and the INSS — which should ensure greater speed and legal certainty in these types of procedures.

Regarding the measures to be taken, Valdés Pérez specifies that the main thing is to get the basics right. Rather than inventing new measures, it’s about correctly applying what the regulations already provide for, along with the interpretations that case law has gradually provided. And he concluded: “These types of rulings aren’t just about benefits; they’re about how a specially protected situation is, or isn’t, protected. In case of doubt, the Administration should lean towards effective protection, both for the mother and the children, taking extreme precautions. What is not appropriate is for the worker to have to assume the risk due to the actions of the administration.”

‘In Surgery, It’s Not Always Possible to Decide When to Stop’

Inés Rubio-Pérez, MD, PhD, a colorectal surgeon and coordinator of the surgical infections section of the Spanish Association of Surgery (AEC), told El Médico Interactivo that surgery is compatible with breastfeeding, but in practice it can be “difficult.” “Surgery is a specialty with unpredictable schedules, lengthy operations, and a heavy patient load. This means that continuing to breastfeed requires a significant personal effort. Many female surgeons manage to do so thanks to strong organizational skills and the support of colleagues and family members, but it shouldn’t depend solely on individual willpower. I believe there is still room for the system to better facilitate this work-life balance,” Rubio-Pérez explained.

The surgeon points out that the main difficulty is the workload and the lack of control over schedules. In surgery, it’s not always possible to decide when to stop, delay a procedure, or step away for a few minutes. Furthermore, on-call shifts, schedule changes, and emergencies make it difficult to maintain a stable pumping or breastfeeding routine. Added to this is the physical and mental exhaustion inherent to the specialty, especially in the first few months after returning to work.

Long and unpredictable surgeries also play a role. Some can last several hours, and their duration cannot always be anticipated. This can force mothers to delay feedings or pumping sessions longer than recommended, with the discomfort and negative impact this has on milk production and even mastitis. “The difficulty isn’t just finding the time but being able to do it with some peace of mind and on a regular basis,” Rubio-Pérez noted.

The surgical environment has very strict standards to ensure sterility and asepsis. If the surgeon leaves the operating room to express milk, upon returning, she must perform surgical hand washing again and put on a sterile gown and gloves. Furthermore, once a procedure has begun, leaving the operating room may not always be feasible; it depends largely on the stage of the surgery or whether another surgeon is available to continue independently. These are constraints inherent to the specialty.

The surgeon proposes several measures: providing nearby, suitable spaces for breastfeeding; allowing for some organizational flexibility when possible; facilitating coverage by colleagues at specific times; and normalizing these needs within departments. “It’s not about reducing professional commitment, but rather about making the profession compatible with a very demanding stage of life,” Rubio-Pérez said.

“I’d like to emphasize that many female surgeons manage to continue breastfeeding despite the difficulties, and that demonstrates enormous personal commitment, one that is worthy of praise. At the same time, it’s important to convey that every situation is different and that no professional should feel judged for the decisions she makes regarding breastfeeding, but she should be able to choose freely and have support within the hospital setting. Talking about these challenges openly and realistically can help continue to improve conditions for future generations of female surgeons,” Rubio-Pérez concluded.

The AEC is currently working on a document of recommendations for pregnant female surgeons, and they hope to include breastfeeding in it, as the surgeon revealed to El Médico Interactivo.

Intensive Care Physicians Cannot Delay Patient Care

María Isabel Rubio López, MD, an intensive care physician, Marqués de Valdecilla University Hospital, Santander, Spain and coordinator of the gender gap group at the Spanish Society of Intensive Care Medicine and Coronary Care Units, explained to El Médico Interactivo that continuing breastfeeding in an ICU requires pumping breast milk and support from those around you. “And even then, it’s very difficult,” she said. The doctor explained that, in most cases, “mothers resort to mixed feeding or wean their babies from breastfeedingentirely.”

The specific challenges faced by intensivists stem from a lack of time and availability to breastfeed during work hours, especially during on-call shifts. “On the other hand, there are factors inherent to the specialty, such as stress and fatigue, that can affect milk production,” she added.

“The unpredictability of both work and the baby puts the mother in a constant internal dilemma. In our specialty, we cannot afford to delay patient care, and that means that if you want to continue breastfeeding optimally, you must consider requesting time off or even not working or changing your workplace,” she stated.

The clinical workload and organizational pressure on these healthcare professionals regarding breastfeeding have a “very negative” impact. In the words of the intensive care specialist: “It creates a mental and physical overload that directly affects breastfeeding and the mother’s health. Healthcare professionals’ high expectations of themselves sometimes make it difficult for them to recognize their own vulnerabilities and cause them to continue shouldering a burden that can ultimately take its toll. Furthermore, organizational and patient-care pressures affect all healthcare professionals, which strains workplace relationships and even brings out a certain degree of sexism in some. When you return from maternity leave, these subtle forms of sexism become much more evident.”

Regarding the availability of spaces for pumping breast milk, she noted that, in some hospitals, there are lactation rooms, but none specifically designated for ICU staff. “The spaces are usually small and open to mothers visiting the hospital and clinics, so you might go there and find that there’s no room,” she emphasized.

From her perspective, it is essential to develop policies that support female professionals in effectively balancing work and family life without penalizing them. “We know that the current organizational system is leading to an overload of patient care, stress, and physical and mental exhaustion among healthcare professionals. We need an organizational change free of sexism that guarantees real flexibility in work schedules without further overburdening an already strained system,” she said.

“As healthcare professionals, we know the benefits of breastfeeding. Walking into the hospital where you work and constantly seeing pro-breastfeeding campaigns, only to find that you — working there — can’t continue breastfeeding because of a lack of support measures, is a hypocrisy of the system,” she denounced.

The intensive care specialist concluded: “Current measures supporting breastfeeding and work-life balance are insufficient, especially if you’re a single parent, as in my case. Balancing work and family life isn’t a lack of professionalism. A mother shouldn’t have to choose between being a good professional and being a good mother. A system that truly cares about maternal and child health must promote effective work-life balance measures.”

This story was translated from El Médico Interactivo on Univadis, part of the Medscape Professional Network.