{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,15]],"date-time":"2026-08-15T12:26:54Z","timestamp":1786796814910,"version":"build-2736575974"},"reference-count":22,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Joint Schools of Public Health"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Hum Lact"],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Breastfeeding remains the recommended feeding method during public health emergencies; however, pandemic-related restrictions created new challenges for mothers and their healthcare teams, including lactation professionals (LPs). The COVID-19 pandemic may have heightened LPs\u2019 occupational stress and limited their ability to provide lactation support.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Research Aims:<\/jats:title>\n                    <jats:p>This study examined occupational stress among LPs, identified stressors and coping strategies, and explored how pandemic-related workplace policies influenced lactation services.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A mixed-methods design was employed. A cross-sectional online survey assessed the experiences of hospital- and clinic-based LPs during the COVID-19 pandemic. Key informant interviews were conducted to identify stressors, coping strategies, and service delivery impacts. Descriptive and inferential statistics were conducted, and qualitative data were analyzed using reflexive thematic analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The sample included 1,373 healthcare professionals. Most LPs (91.8%) reported moderate to high perceived stress consistent with other studies. Key stressor themes included new policy implementation, evolving personal protective equipment requirements, employment changes, the transition to telehealth, and fear of infection. Participants reported using problem management, emotional regulation, and meaning-based coping strategies. Themes describing impacts on lactation service provision included reduced or delayed support, protected breastfeeding practices, hindered interpersonal connectedness, and telehealth limitations. Clinical policy changes were perceived to both hinder and improve lactation services.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>During public health emergencies, LPs\u2014especially those with dual role responsibilities\u2014require additional support. Interventions should build upon coping strategies identified in this study. Future research should examine how stressors influence service provision, the effectiveness of coping strategies, and the potential role of geographic context in policy implementation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/08903344261470652","type":"journal-article","created":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T05:55:38Z","timestamp":1786600538000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Occupational Stress and Coping During a Public Health Emergency: A Mixed-Methods Approach to Understand the Experiences of Lactation Professionals in Clinical Settings"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0951-4708","authenticated-orcid":false,"given":"Mya","family":"Michele Carter","sequence":"first","affiliation":[{"name":"School of Community and Environmental Health, Old Dominion University, Norfolk, VA, USA"},{"name":"School of Pharmacy, Hampton University, Hampton, VA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Bennington","sequence":"additional","affiliation":[{"name":"School of Community and Environmental Health, Old Dominion University, Norfolk, VA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Kekeh","sequence":"additional","affiliation":[{"name":"School of Community and Environmental Health, Old Dominion University, Norfolk, VA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hadiza","family":"Galadima","sequence":"additional","affiliation":[{"name":"School of Community and Environmental Health, Old Dominion University, Norfolk, VA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,12]]},"reference":[{"key":"e_1_3_3_2_1","doi-asserted-by":"crossref","unstructured":"Al Ateeq D. A. Aljhani S. AlEesa D. AlFaris E. Sonbol H. Alanazi H. (2020). Perceived stress among students in virtual classrooms during the COVID-19 pandemic in Saudi Arabia. Journal of Taibah University Medical Sciences 15(5) 398\u2013403. https:\/\/doi.org\/10.1016\/j.jtumed.2020.07.004","DOI":"10.1016\/j.jtumed.2020.07.004"},{"key":"e_1_3_3_3_1","doi-asserted-by":"crossref","unstructured":"Al Maqbali M. Al Khadhuri J. (2021). Psychological impact of the coronavirus 2019 (COVID-19) pandemic on nurses. Japan Journal of Nursing Science 18(3) Article e12417. https:\/\/doi.org\/10.1111\/jjns.12417","DOI":"10.1111\/jjns.12417"},{"key":"e_1_3_3_4_1","doi-asserted-by":"crossref","unstructured":"Bartick M. C. Vald\u00e9s V. Giusti A. Chapin E. M. Bhana N. B. Hern\u00e1ndez-Aguilar M. T. Duarte E. D. Jenkins L. Gaughan J. Feldman-Winter L. (2021). Maternal and infant outcomes associated with maternity practices related to COVID-19: The COVID Mothers Study. Breastfeeding Medicine 16(3) 189\u2013199. https:\/\/doi.org\/10.1089\/bfm.2020.0353","DOI":"10.1089\/bfm.2020.0353"},{"key":"e_1_3_3_5_1","doi-asserted-by":"crossref","unstructured":"Burrowes S. A. B. Casey S. M. Pierre-Joseph N. Talbot S. G. Hall T. Christian-Brathwaite N. Del-Carmen M. Garofalo C. Lundberg B. Mehta P. K. Mottl-Santiago J. Schechter-Perkins E. M. Weber A. Yarrington C. D. Perkins R. B. (2023). COVID-19 pandemic impacts on mental health burnout and longevity in the workplace among healthcare workers: A mixed methods study. Journal of Interprofessional Education & Practice 32 Article 100661. https:\/\/doi.org\/10.1016\/j.xjep.2023.100661","DOI":"10.1016\/j.xjep.2023.100661"},{"key":"e_1_3_3_6_1","doi-asserted-by":"crossref","unstructured":"Connolly A. Matthews A. (2024). Exploring breastfeeding mothers\u2019 and lactation consultants\u2019 experiences of lactation consultancy throughout COVID-19 restrictions. HRB Open Research 7 Article 9. https:\/\/doi.org\/10.12688\/hrbopenres.13856.2","DOI":"10.12688\/hrbopenres.13856.1"},{"key":"e_1_3_3_7_1","doi-asserted-by":"crossref","unstructured":"Daneshvar E. Otterbach S. (2025). Workplace stressors and burnout among healthcare professionals: Insights from the pandemic and implications for future public health crises. Scientific Reports 15 Article 42015. https:\/\/doi.org\/10.1038\/s41598-025-21540-2","DOI":"10.1038\/s41598-025-21540-2"},{"key":"e_1_3_3_8_1","doi-asserted-by":"crossref","unstructured":"DeCoste K. L. Benoit B. L. Dewart G. K. Johnson S. T. (2024). Registered nurse lactation consultants\u2019 experiences supporting maternal mental health: A qualitative descriptive study. Midwifery 138 Article 104145. https:\/\/doi.org\/10.1016\/j.midw.2024.104145","DOI":"10.1016\/j.midw.2024.104145"},{"key":"e_1_3_3_9_1","doi-asserted-by":"crossref","unstructured":"D\u2019Hollander C. J. McCredie V. A. Uleryk E. M. Kucab M. Le R. M. Hayosh O. Keown-Stoneman C. D. G. Birken C. S. Maguire J. L. (2025). Breastfeeding support provided by lactation consultants: A systematic review and meta-analysis. JAMA Pediatrics 179(5) 508\u2013520. https:\/\/doi.org\/10.1001\/jamapediatrics.2024.6810","DOI":"10.1001\/jamapediatrics.2024.6810"},{"key":"e_1_3_3_10_1","doi-asserted-by":"crossref","unstructured":"Ghahramani S. Lankarani K. B. Yousefi M. Heydari K. Shahabi S. Azmand S. (2021). A systematic review and meta-analysis of burnout among healthcare workers during COVID-19. Frontiers in Psychiatry 12 Article 758849. https:\/\/doi.org\/10.3389\/fpsyt.2021.758849","DOI":"10.3389\/fpsyt.2021.758849"},{"key":"e_1_3_3_11_1","doi-asserted-by":"crossref","unstructured":"Heise M. Madi M. Mattern E. Stengler A. Steckelberg A. (2025). Effects of the COVID-19 pandemic on working conditions of maternity staff: A scoping review. BMC Pregnancy and Childbirth 25(1) Article 855. https:\/\/doi.org\/10.1186\/s12884-025-07905-5","DOI":"10.1186\/s12884-025-07905-5"},{"key":"e_1_3_3_12_1","doi-asserted-by":"crossref","unstructured":"Hoying R. Badreldin N. Shah M. D. Bolden J. R. Cummings P. Robinson D. T. (2022). Providing breastfeeding support during COVID-19: A survey of staff experiences. Journal of Human Lactation 38(1) 43\u201352. https:\/\/doi.org\/10.1177\/08903344211047843","DOI":"10.1177\/08903344211047843"},{"key":"e_1_3_3_13_1","unstructured":"International Board of Lactation Consultant Examiners. (n.d.). What is an IBCLC? https:\/\/iblce.org\/about-iblce\/"},{"key":"e_1_3_3_14_1","doi-asserted-by":"crossref","unstructured":"Joshi K. Modi B. Singhal S. Gupta S. (2023). Occupational stress among health care workers. In Identifying occupational stress and coping strategies. IntechOpen. https:\/\/doi.org\/10.5772\/intechopen.107397","DOI":"10.5772\/intechopen.107397"},{"key":"e_1_3_3_15_1","doi-asserted-by":"crossref","unstructured":"Kader N. Elhusein B. Chandrappa N. S. K. Nashwan A. J. Chandra P. Khan A. W. Alabdulla M. (2021). Perceived stress and post-traumatic stress disorder symptoms among ICU staff caring for COVID-19 patients: A national study. Annals of General Psychiatry 20(1) Article 38. https:\/\/doi.org\/10.1186\/s12991-021-00363-1","DOI":"10.1186\/s12991-021-00363-1"},{"key":"e_1_3_3_16_1","doi-asserted-by":"crossref","unstructured":"Koleilat M. Whaley S. E. Clapp C. (2022). The impact of COVID-19 on breastfeeding rates in a low-income population. Breastfeeding Medicine 17(1) 33\u201337. https:\/\/doi.org\/10.1089\/bfm.2021.0238","DOI":"10.1089\/bfm.2021.0238"},{"key":"e_1_3_3_17_1","volume-title":"Stress, appraisal, and coping","author":"Lazarus R. S.","year":"1984","unstructured":"Lazarus R. S., Folkman S. (1984). Stress, appraisal, and coping. Springer."},{"key":"e_1_3_3_18_1","doi-asserted-by":"crossref","unstructured":"Li R. Perrine C. G. Anstey E. H. Chen J. MacGowan C. A. (2022). Breastfeeding and post-perinatal infant deaths in the United States: A national prospective cohort analysis. The Lancet Regional Health \u2013 Americas 5 Article 100094. https:\/\/doi.org\/10.1016\/j.lana.2021.100094","DOI":"10.1016\/j.lana.2021.100094"},{"key":"e_1_3_3_19_1","doi-asserted-by":"crossref","unstructured":"Lubbe W. Niela-Vil\u00e9n H. Thomson G. Botha E. (2022). Impact of the COVID-19 pandemic on breastfeeding support services and women\u2019s experiences of breastfeeding: A review. International Journal of Women\u2019s Health 14 1447\u20131457. https:\/\/doi.org\/10.2147\/IJWH.S342754","DOI":"10.2147\/IJWH.S342754"},{"key":"e_1_3_3_20_1","unstructured":"Office of Disease Prevention and Health Promotion. (n.d.). Infants. Healthy People 2030. U.S. Department of Health and Human Services. https:\/\/odphp.health.gov\/healthypeople\/objectives-and-data\/browse-objectives\/infants"},{"key":"e_1_3_3_21_1","doi-asserted-by":"crossref","unstructured":"Popofsky S. Noor A. Leavens-Moore J. Vieira L. Cordeiro L. Buqo T. Razavi A. S. (2020). Impact of maternal SARS-CoV-2 detection on breastfeeding due to infant separation at birth. The Journal of Pediatrics 226 64\u201370. https:\/\/doi.org\/10.1016\/j.jpeds.2020.08.004","DOI":"10.1016\/j.jpeds.2020.08.004"},{"key":"e_1_3_3_22_1","doi-asserted-by":"crossref","unstructured":"Salari N. Khazaie H. Hosseinian-Far A. Khaledi-Paveh B. Kazeminia M. Mohammadi M. Eskandari S. (2020). The prevalence of stress anxiety and depression among frontline healthcare workers during COVID-19: A systematic review and meta-regression. Human Resources for Health 18(1) Article 100. https:\/\/doi.org\/10.1186\/s12960-020-00544-1","DOI":"10.1186\/s12960-020-00544-1"},{"key":"e_1_3_3_23_1","doi-asserted-by":"crossref","unstructured":"Schindler-Ruwisch J. Phillips K. E. (2021). Breastfeeding during a pandemic: The influence of COVID-19 on lactation services in the northeastern United States. Journal of Human Lactation 37(2) 260\u2013268. https:\/\/doi.org\/10.1177\/08903344211003898","DOI":"10.1177\/08903344211003898"}],"container-title":["Journal of Human Lactation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/08903344261470652","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/08903344261470652","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/08903344261470652","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,15]],"date-time":"2026-08-15T11:54:01Z","timestamp":1786794841000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/08903344261470652"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,12]]},"references-count":22,"alternative-id":["10.1177\/08903344261470652"],"URL":"https:\/\/doi.org\/10.1177\/08903344261470652","relation":{},"ISSN":["0890-3344","1552-5732"],"issn-type":[{"value":"0890-3344","type":"print"},{"value":"1552-5732","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,12]]},"article-number":"08903344261470652"}}