WWhen my daughter started to reveal how comfortable she was in utero, and had no intention of leaving anytime soon, I immediately sent a message to my obstetrician: “I need to be induced. I was worried that I would have enough time off my Adolescent Medicine scholarship.
She scheduled me for an induction in a few days, nodding gently as she told me that she too was past her due date and watched her maternity leave go by.
My fellow residents and attending physicians, almost all women, have spoken openly about their own struggles as physician mothers. When I returned to work after six weeks, much to the surprise and sympathy of my colleagues, I explained that the direction of our program – and my recovery – was at the behest of the American Board of Pediatrics.
This council, a licensing body, has a list of strict policies for pediatric scholarships, including this one: a fellow cannot take more than 12 weeks of leave without extending their three-year training program. Because maternity leave is counted in those 12 weeks, I made a calculated decision not to spend all of my leave in one year. What if my daughter, Meera, gets sick, or if my parents or my husband’s? In a year when the unimaginable has become a daily reality, I would have to extend my training, which for adolescent medicine is already undoubtedly too long.
The irony that the American Board of Pediatrics has this stipulation is not lost on interns in the field who are learning the benefits of breastfeeding, including advising patients not to start pumping for six weeks. Realizing the decrease in the sand in the hourglass, I began to draw at three weeks, crying at the sight of how little milk I could produce.
I was also blissfully unaware of the difficulty of my physical recovery after childbirth. I had run 4 miles a day during my 39th week of pregnancy, had normal blood pressure and reassuring prenatal tests calling me “low risk,” and even the induction was relatively mild: Meera emerged after a hour and a half push. Still, a lip tear left me on my knees for weeks as I was bleeding profusely. For over a month, I had trouble emptying my bowels, urinating, laughing and coughing. To go to the bathroom, I needed to wedge myself against the wall.
Running was my way of staying sane during my pediatric training. In his absence, I found myself sobbing at how weak and bedridden I had become. I hated to hear that real physical and emotional trauma was called something as mild as the “baby blues”.
In any context other than childbirth, even the most negligent of treating physicians would hesitate to send home a patient from the hospital who could not walk, had lost urinary continence and was soaking an industrial-sized compress with blood every hour. . The physical and emotional difficulties continued over the next six weeks.
As a resident, I remembered the countless times I have examined women for postpartum depression on their first visit to a newborn baby without anyone else ever testing positive. In filling out my own form, I felt ashamed to admit depression even though I had a beautiful, healthy baby. “Were my patients also afraid to answer honestly? ” I was wondering.
Even with my training in pediatrics, I have never properly recognized how integral maternal health is to infant well-being – how laborious it is to breastfeed when you are, as stated. a new mother, “sweet and broken”; how long can physical recovery take when caring for a demanding newborn; and the help new mothers need from family, friends, physiotherapists and other health care providers.
And even with all the support I have, I still got to work overwhelmed and unprepared. I was inadvertently breastfeeding, so I made sure I never left the house without wearing a zipped jacket over my shirt. My hips were loose, my walk unsteady. When I walked fast, my bleeding also accelerated, so I continued to wear postpartum pads to work. And my mind was divided by anxiety and postpartum depression: Was I a good mom? Did my parents and in-laws judge me for leaving such a young baby? Could I walk through the clinic without pumping? If I couldn’t, would my colleagues judge me?
It was difficult to deal with worried parents when fears of my own inadequate parenting generated their own statics.
When the American College of Obstetricians and Gynecologists published postpartum care guidelines in 2018, he acknowledged how sloppy the nation’s policies have been in caring for those who literally secure his future and reinvented postpartum care as more than a one-time six-week clearance where the we cross the Rubicon to return to normal. Instead, the guidelines recommend a 12-week interval of examinations that are both more frequent and meaningful than ensuring the healing of stitches – understanding the “fourth trimester” as a complex web of mental, social, sexual changes. and emotional that physician mothers are not exempt from.
It has now been 13 weeks since Meera was born. She now sleeps for longer periods of time (although we are certainly preparing for a regression in sleep). I can comfortably pump enough milk to hold her when I’m at work. I started a postpartum support group that I lean on for the toughest days. I can run again. And I needed each of those 90+ days to heal.
There must be a change in policy on the part of the organization that advocates for the welfare of children. The total number of leaves granted during a pediatric internship cannot be equal to a standard maternity leave of 12 weeks. Pediatric specialists are already scarce due to extensive training requirements and lower salaries. Women continue to be the majority of pediatric providers, and peak childbearing years overlap with stock market education.
Rigorous scholarship training and maternity leave need not be mutually exclusive. There is no more rigorous training for a pediatrician than having a newborn page every two hours requiring you to tinker with a differential diagnosis: drowsy, tired, hungry, wet. There are ways that scholarships can help structure maternity leave in a meaningful way to meet program requirements. My residency program at the University of New Mexico featured a generous elective course for new parents where residents could have a free month after using annual leave to discuss how parenting has changed their approach to children. patients and families; their own challenges and prejudices; and their growth as parents over the month.
With a three-year postgraduate pediatric education, sufficient optional time could allow a similar approach. In adolescent medicine, this could be a month-long internship in which new physician parents could virtually meet with adolescent parents once a week. There are so few opportunities for patients and physicians to speak truly and as equals, humbled by the same challenge. I can imagine similar approaches where a mentor could guide other specialist fellows through cases around their areas of interest once a week to discuss how they might approach counseling, discussing a diagnosis, and limits patient expectations differently with the experience of parenthood.
If we expect women to continue caring for children as doctors and parents, we cannot continue to burden them with short and impossible maternity leave. the American Board of Obstetrics and Gynecology offers up to 12 weeks of leave in a single year for their scholarships, a total of up to 20 weeks of leave for their three-year scholarships and 16 weeks for their two-year scholarship. If the American Board of Pediatrics cannot be the leader on this issue, it must at least become a follower.
Megana Dwarakanath is a Fellow in Adolescent Medicine at the University of Pittsburgh Medical Center.