Tuesday, July 12, 2011

Is 12 weeks long enough?

I was recently on the phone with a friend of mine who is 40 weeks pregnant. (My husband has dubbed 2011 "The Year of the Baby" because pretty much every couple we know is having a baby.) She was having very painful contractions that were coming at regular intervals.

"I think you should go to the hospital," I told her.

"No, I can't," she said. "I still have to go to work tomorrow so it won't count as a day off."

I can't throw stones. I spent most of the day I went into labor having contractions at work that were increasingly painful, and ignored the charge nurse yelling at me that she was NOT going to be delivering my baby. I had to get my work done for the day so that it would "count." (In my defense, the contractions were still 15 minutes apart when I finally went home.)

Honestly, I liked it that when people asked me when I was due, I could reply, "Tomorrow." I was proud of myself for working till the day I went into labor for two pregnancies. But that was pretty much all I liked. The last two weeks of pregnancy were an uncomfortable blur of swollen and achy feet, exhaustion, having to pause dictations multiple times to catch my breath, and Braxton-Hicks contractions that liked to come when I was driving. If staying home during that time wouldn't have cost me any money or time with my baby, I wouldn't have hesitated to do so.

FMLA guarantees 12 weeks off. That seems like a long time in some ways, probably the longest I've gone without work or school since I was three years old, but it also means you're going back to work and leaving a two and a half month old baby behind. It means that you don't want to sacrifice any of that time to stay home without a baby in your arms.

And a lot of residents and other professionals take far less than 12 weeks off. I know many women who took only 6 weeks off. I know a few who only took 4 weeks off.

This is not unique to medicine. Most of the women I know in other fields also worked until the bitter end. I don't know any who were happy to be still working at 40 weeks, but it's a necessity when the law only gives us a maximum of 12 weeks, and often that time is unpaid. Canada gives women a whole year to spend with their babies.

I'm not sure I'd enjoy taking a whole year off or if I'd really do it. But it would certainly be nice to live in a country where it was an easy option.


  1. Coming from Canada where we get a year off...I simply can't imagine going back to work after 12 weeks! You still aren't getting any sleep and are barely recovered from childbirth. We get paid minimally for that time though, by the government, not our employers, so for some even though they have to hold your job, the year off isn't feasible. I think somewhere in the neighbourhood of 6 months off might be a happy medium.

  2. A year does seem very long. When I took only 8 weeks during residency, I said that next time I wanted to take 6 months. Apparently, I lived in fantasyland, but that would have been a good amount of time.

  3. "Canada gives women a whole year to spend with their babies."

    But not if the woman is self-employed, which the vast majority of physicians are.

    In BC, physicians can get 17 weeks of leave at a percentage of their regular billings.

    I'm taking 31 weeks, with zero income for the last 14 weeks.

  4. Martina: Still way better than what we get.

  5. As a Canadian, I loved having the option of taking a year off. I had my first baby as a resident and took 6 months off (a year felt much too long to be away from medicine, but 6 months was just right) and I was also off at 34 weeks due to BP issues w/ my pregnancy.

    Now I'm a self-employed family doc pregnant with #2...so I'm down to 17 weeks (and just hoping my BP behaves so I can spend it all with the baby instead of using some beforehand).

    I truly can't imagine just 12 weeks (or less)!!

  6. 12 weeks... and NONE of it paid. Well, aside from vacation/sick time acrued by not taking any vacation or sick days for a year.

  7. I think a year would be amazing. but then again I'm not a dr yet, just a med student.
    my son was born in feb 2010 and I stayed home with him for six months, until school started that august. I'd have stayed another six months in a heartbeat.
    however, I also was unpaid after my first 12 weeks (which I'd earned as a nurse). I ended up taking out part of my retirement to help us get by until school started and my loans came in. Id do it again in a second. but I'd also be ecstatic to see a longer leave as an option. A girl can dream.

  8. arghhh - no 12 weeks is not enough! And although I think a year is a lot, the culture in the US makes taking more time the exception instead of the norm. The culture here needs to change. We deserve a change. We deserve to have better options without guilt, and mommy tracking and discrimination by colleagues. Most residents here take 6 weeks. I took 8 and felt a lot of guilt for it and worked from home the last two. However, as I watch my daughter grow, I really feel that more time is important. We've had residents, post c-section, back in less than 6 weeks, operating on long cases while still recovering from abdominal surgery - working harder and longer than everyone else because of their 6 week "vacation." The culture needs to change. Lets lead the charge!

  9. 12 weeks is plenty of time! I was dying to go back to work at that time. But, I have to also clarify that I'm an attorney, so I was going back to a full-time desk job while my husband, who was doing a fellowship, took a 12 week leave right after mine. It made my transition back to work very smooth. I would be no good at a full-time mom gig and I was more than ready to have adult interaction and convserations at 12 weeks.

  10. The first part of this post made me smile with recognition - I too went to work the morning I was in labor (3 days past my due date!). Sure, I was having contractions, but labor takes a long time...I work at the hospital anyway, might as well go!

    It was super hard to concentrate on grand rounds that day.

    I firmly, strenuously believe that every woman should get to decide what is the right amount of time to stay home with her baby, and I think 6-12 months of paid maternity leave would be "right" for our country. Even if it wasn't paid, you should be able to do a no-penalty leave of absence, rather than 12 weeks if you are in medicine.

    I went back to work after each of my kids was 11 weeks old, and although I do not want to be a SAHM at all, that just seemed like way to soon. I felt like all my babies needed for about the first 6 months was me, and my cuddling and my breastmilk, and boy do I wish I had been able to give them that without derailing my medical training or getting evicted. Maybe by the time my daughter is 30 we'll have figured something out...

  11. I guess I'll have to be the devil's advocate here. I believe that having a child is a personal choice, and as such, it's a woman's personal responsibility to plan for that event, including how she will finance her leave. I just don't believe it's the role of the federal government to subsidize my choice to have a child. It's my responsibility to plan for the time I will want, and the finances that come with it. Is it really fair to ask those who choose not to have children to pay for those who do? How about women who have 6 children. Is it fair to ask the government to compensate them for 6 years of being home, and to ask their company to hold their position for 6 years? I just don't think it is. I view my job as a partnership in which I am being compensated for work that I do, when I'm not doing that work, I'm not entitled to compensation. Now, if private companies want to offer paid maternity leave as a part of a competitive benefits package to entice employees, I would more than happily support that!

  12. Cutter: Yes, it's incredible how much guilt there is associated with taking maternity leave in this country. Like you, I took 8 weeks during residency (rather than 6) and felt like everyone was judging me for taking too much leave.

    Anon: I might feel better about it too if I had a family member who could stay with the baby for an extra 3 months.

    KGood: There was another woman who I work with (not a physician) who gave birth a month before I did and similarly had to be forced out the door while having contractions. I agree with everything you said... babies, especially ones that are nursing, really need their mamas during those first 6 months.

    Kelley: I understand what you're saying, but there are arguments for why the government might finance a longer maternity leave... that it has health and other benefits to the child that ultimately benefit society. And some states do have short-term disability for this purpose. But even if the maternity leave isn't paid, the fact is that most women in this country cannot take more than 12 weeks off, paid or unpaid, without risking permanent loss of their job. Basically, your choice is to go back to your job way too soon or give up your job completely. That is what seems unfair to me. Like KGood said, there should at least be a no penalty leave of absence allowed.

  13. I worked past my due date then took 6 wks as a resident and then to my due date (stopping only as I would "lose" the days accrued due to the calendar any way) and a whopping 8 wks as an attending - most of it paid but also using all vacation/personal days available. Why so short? out of guilt, out of financial realities, for all the US-based reasons people have stated... I would have loved to have 6 months to devote to my babies, but was luckily able to have my husband be home with them so it wasn't as excruciating as it could have been.

  14. I took 10 weeks of full maternity leave, and then I worked from home doing research until my son was 8 months old. I wish I had stayed home with him until he was a year old. After that, I ended up hiring a nanny because he got too sick at daycare. I appreciated the option to be at home with him that long. If I have another child when I'm in residency, I will take off the maximum time I can, hopefully 6 months, and make up the time at the end of residency (therefore graduating late). I do not feel guilty at all for staying home with my child, and I get angry when I think about the culture of some medical training programs that look down upon mothers who take time off for maternity leave. We are physicians -- we are told to take care of others as a profession. Our own children deserve exactly the same, if not more from us, since they are ours.

  15. i think our country is hypocritical when it comes to this... the "healthy people 2010 and 2020 guidelines" are never met for breastfeeding markers at 6 months and a year... it seems if we truly valued that as a country, giving more extended maternity leaves would be one step in the right direction to doing so.

  16. Two of my fellow residents recently had babies. One of them was in the operating room at 1 pm and then walked over to L & D and had her baby a few hours later. She is planning on coming back after 4 weeks, because she could potentially loose a fellowship spot if she takes more time off.

    12 weeks isn't actually an option for us. We would be completely unpaid for 6 weeks, which is financially impossible for us. It breaks my heart leaving my babies at such a young age, but right now, that's the only option we have. Which is one of the reasons we aren't having another one any time soon.

  17. I definitely do not think 12 weeks is enough, and I certainly do not/would not feel guilty taking more time, nor taking time prior to delivery to rest before the baby arrives.
    I am a family physician - Canadian raised and trained but currently living and working in Houston. I am about 30 weeks pregnant and recently approached my 'employer' about taking an extended, unpaid leave beyond the 8-12 weeks they grant for maternity leave. I told them I wanted to spend about 5-6 months total with the baby.
    Their response? They could not agree to this and guarantee me my job and they feared that allowing me to take an unpaid leave would set a precedence for other women.
    A precedence for caring for their own children post-partum?
    I am in family medicine for goodness sakes, and I do a lot of maternity care and promote breastfeeding.
    Basically I will see how this goes, and if I need to find another job I will.
    Definitely not happy that I'm in the US having a baby.
    I think the American 'culture' is so non-supportive of pregnant women and mothers in general, and I think it's sad.

  18. This is anon again (my name is actually Jen). Could someone please set Kelley straight? The federal government does not pay for anyone's leave!! (Well, unless you're a federal employee -- but then you're only able to take paid leave for what you've earned.) The FMLA only requires that employees basically not fire workers for taking leave for, among other medical "disabilities" (as defined by the act), pregnancy. The FMLA doesn't require a dime of pay -- it only requires that you be able to take up to 12 weeks in one calendar year for family leave. So Kelley -- you're right; it's not the government's job. But I do think a market place that puts a value on families is important. I like to think that the fact that my firm paid for 12 weeks of leave (their choice; not mandated by law) shows that they value female attorneys and are willing to offer benefits to pay the best workers.

    Oh, and I know I'm out of place here because I'm not in medicine. But I really enjoy reading this blog and am secretly envious of my husband's career in medicine -- I guess I'm a MIM wannabe. :)

  19. Dear Kelley,

    Regardless of personal opinion or political leaning, women's bodies are designed to be in peak reproductive form between the ages of 17 and 27 (give or take a few years on either side). This also happens to be an age during which the vast majority of members of our society are honing a skill set or obtaining an education to expand their existing skill set in order to be and become productive members of society. Only an infinitesimally small percentage of the 20 to 30-year-old women have the means to support themselves through a reasonable maternity leave (if you come from a wealthy family, have a trust fund, or married a man 20+ years your senior who has already accumulated adequate financial resources, good for you! and you are in the negligible minority).

    Thus, if in 25-30 years from now you want to have a healthy and intelligent set of people to be your doctors, nurses, engineers, etc. and to make sure that you and I (as individuals) and our country do not fall apart without any hope of repair, then I suggest you lay aside the myopic and misguided "Atlas Shrugged" attitude and pitch in to support the mothers and babies and schools of today.

    I don't ride a bicycle, but I gladly contribute a part of my income (taxes) for the nicely paved bicycle lanes that you may be using. I also gladly pay for the fire engines that may come to rescue you some day, even if I never see any personal benefit from them. I could go on and on with lots of (even more coherent) examples. By your logic, if someone does not like the root and the meaning of the word "society" then it's their personal responsibility to plan their lives in such a way as to be able to purchase an island and live there governed by their own personal laws.

    Sorry if this is unpolished or worded too strongly - I'm in the middle of a billion things right now and don't have time to edit.

  20. Great response Kelley, I totally agree!

  21. I had a child at age 38, in the "bad old days" before FMLA..
    we had a research grant due so I worked on a Friday (with my feet elevated on a desk drawer)and before I left that night delivered a data disk to the analyst. I had the baby at 12:30 PM on Saturday and was back at work 9 days later (My PI said, "I KNEW you wouldn't last 6 weeks") finishing work on the grant...

    I had saved vacation time for 2 years to be able to take a 6 week leave that would be paid...

  22. I was one of the four-weekers with my first child. But that was because I started medical school when she was four weeks! I was 35 and just didn't feel I could wait another year. I took a whopping 8 weeks with the second (at the beginning of my 3rd year of med school). I was fortunate that my husband had a more flexible schedule at that time.

  23. Depends where you live in Canada, and how you are paid. As a salaried family doc in New Brunswick, I received 75% of my salary for 17 wks and then qualified for Employment Insurance for up to 35 additional weeks. It's wonderful ....assuming you can find locum...not so easy.

  24. Quick note for Canadians. Self-employed people CAN opt in for paid leave now:


    I found out about it too late and also hesitated to opt in to EI for the rest of my life.

    I'm on mat leave now with my 7.75 mo old, in Canada, unpaid. We have the money--one of the benefits of having a second baby relatively late. I will go back to the emergency room, but on my own timetable. I'm working hard on my second career (writing) and I literally have my hands full most of the time.

    So, is 12 weeks long enough? For some people, sure. Others, not. I'd rather have the choice and not the shame/guilt.

  25. I only got 4 weeks "off" with my daughter. I had a little bit of a different situation though. I'm still a student, so after 4 weeks I went back to school full time, and a part time job, which is quite a bit with a new baby, but much more flexible than as a physician. I'm grateful my daughter came 2 weeks before her due date so she wasn't just 2 weeks old when the school semester started and I left.

    I was actually really grateful to return to school & work. I loved returning to sense of normal and routine. I felt like the familiar environment of school helped ground me and gave me some confidence during that time where I felt like my life was a whirlwind.

  26. I suppose in some ways, it would be nice to have longer guaranteed maternity leave. The problem is that nobody ever looks at the downside. Women who are in their 20s and 30s are already looked at as people who are likely to reproduce and take time off of work, which contributes to increased difficulties finding jobs and lower wages. Suppose we went to a model where women were guaranteed a year off. Now, suppose you were an employer. It doesn't matter if it's "illegal," but suppose you have two equally qualified candidates for a job opening: a man, and a 22-38 year old woman. I can tell you that I would hire the man in a heartbeat.

    I'm sure people will say, "This never happens in Canada!!" or, "You're a terrible person if you would hire the man!" or what have you. Fact is, this type of discrimination DOES happen all over Europe because of their lenient maternity leave policies.

    Now consider being a woman who never has any children. Is it really fair to subject her to a lifetime of lower income and reduced job opportunities just because she has a uterus?

    Look, babies are wonderful, motherhood is wonderful, etc. Free money is wonderful. I just thought that someone needed to present the other side to consider: as a society to we value babies more than we value equality?

  27. Christie: Regardless of baby, I don't think I physically could have even done my job at 9 days PP. I could barely leave the house for the first week.

    OMDG: You make some good points and I don't have a great answer. Unfortunately, men and women are not equal.... we have no choice but to be the ones to have the babies. Yes, there are women who opt not to have kids and it's too bad that they have to be discriminated against because of the rest of us. I don't know what the answer is, but I don't think the answer is to sacrifice the time mothers are allowed to spend with their newborns. Women already torture themselves trying to do everything men do while having babies as well... I think some allowances make life more livable.

  28. Heidi: Probably the biggest reason why I couldn't take more time off was the locum issue. There was nobody that could be hired temporarily to do my job (my boss tried to find someone but couldn't), so I felt bad taking longer amounts of time off, knowing others were doing coverage. That is something that I guess isn't specific to this country.

  29. Fizzy -- I don't know what the answer is either. You say that some allowances make life more livable, but you need to think of for whom. Perhaps it would make things more livable for women who currently are employed in a job they love. But perhaps the allowances would make things LESS livable for a woman who currently has 3 children to support, no spouse, who is currently looking for a job.

    Just throwing it out there. I realize that men and women aren't "equal" in the reproductive sense of the word. However, this isn't about making women do the same things that men do AND have the babies too. It's about condemning some women to poverty because nobody will hire them out of concern that they might have children and be away from work for a year. Is that the direction we want to head in as a society?

  30. "Now, suppose you were an employer. It doesn't matter if it's "illegal," but suppose you have two equally qualified candidates for a job opening: a man, and a 22-38 year old woman. I can tell you that I would hire the man in a heartbeat."

    Actually, it does matter that it's illegal and companies get sued for this type of behavior all of the time. And they lose. Believe me, I know, and can rattle off countless judgments in employees' favor.

    Our system is not perfect, but the FMLA is a damn good law when it applies. And many states have gone beyond the FMLA and imposed even more employee (and family) friendly laws upon emloyers and companies.

    It makes me a little sad that people have so little faith that people follow the law.

    Simply having women in the workforce is a benefit to societies and companies. Statistics actually show that having female leadership in companies actually causes the companies to make MORE money, not less. When we look out for the interests of diversity and families, everyone benefits. If a woman spends ages 22-65 (give or take) in the work force, and takes a few months to years off, in the grand scheme of things, she's actually contributing a lot to the market place. Smart employers know this.

  31. Fizzy - Regarding rebounding in 9 days (under self-imposed pressure). I know that there are lots of OBs who dispute this (mine did) but "easy" deliveries run in my family. My first (and only)delivery started with the first contraction at about 8 AM on a Saturday morning and i had the baby only a few hours later. I was at the grocery store the next day (yes, I let somebody else lift the bags and load the car). I come from "good peasant stock" and was told to "warn my OB if I ever had a second child" so that they wouldn't tell me to wait before coming to the hospital..

  32. Really Jen? If they were equally qualified, do you suppose the woman would have a leg to stand on legally?

  33. Jen,
    I'm very sorry you are "sad," but you are also very naive to think that this sort of thing doesn't happen all the time with no legal repercussions.

    Are you suggesting I think FMLA a bad law? I do recall reading a somewhat controversial paper on wage inequality years ago that showed that the only year that wage disparities between men and women increased over the past 30 years was the year after that law was enacted... But again this is not a question of "right" vs. "wrong". It's a question of tradeoffs, like all policy questions are.

  34. Hi Jen,

    hate to say it, but OMDG is absolutely correct. I trained in Germany, and hiring bias is EXTREMELY prevalent, not just in Medicine but everywhere. It's extremely hard to prove, and while there may be a lot of (well publicised) cases where someone sued, and won, there are many, many more that didn't.

    Now we can argue about why didn't they sue, and that's another debate entirely.

    However, hiring bias is VERY real in Germany, a country with 12 months of paid maternity leave at 70 % of pay (up to a cap which is some where in the 2k's per month, I believe).

  35. Maybe the answer is to provide employer incentives for hiring women to balance out a loss caused by a maternity leave.

  36. As a Canadian urology resident, I'm taking 12 weeks off in my third year for mat leave. It'll be tough but either you take a bit of time off and have it waived by the Royal College, or you just go for the full year of mat leave and finish with the next year's cycle.

    At this point, I really don't want to repeat any time. In my chief year, she'll be old enough to tell me I don't spend enough time with them! :(

  37. OMDG
    You state that
    " It's about condemning some women to poverty because nobody will hire them out of concern that they might have children and be away from work for a year. Is that the direction we want to head in as a society? "
    That is my problem with this whole thing and how a certain type of mentality will fear that society will head into THIS direction.
    Society does NOT have to head into this pessimistic direction if more people supported women having children!
    We do have choices as a society...things do not have to be so grim for MIM or mothers in general.

  38. Fizzy, Where do the employer incentives come from? How do you rank that as something to pay taxes for compared to schools, vaccinations, subsidized child care, medicaid, medicare, etc?

  39. Anon on July 17: Our government already subsidizes far more useless things than allowing an infant to be cared for by their own mother. But if that makes you unhappy, then perhaps large companies could be required to employ a certain percentage of women, much like they're required to provide their employees certain benefits.

  40. Tradeoffs, people. Nothing is free. It's not about fear, or being anti-baby. It's about real life.

  41. Real life huh? Well women have been through enough in my opinion. You've got the kinds that give up their job/career completely to be with their kids, the kinds the try to balance it all at the same time and the types that wait long years to succeed in their career and have kids when they're ready. I have a friend, a wonderful pediatrician I might add, who is 49, married recently and just have IVF! And now our employer is giving her a hard time about taking a medical leave (she is on bedrest for god's sakes).
    Basically women need more support and instead of discouraging women to spend a longer time with their infants for fear that it will set a precedence for the rest of society and that society will be unsupportive because of all these women having babies and wanting exra time off, why can't we fight for it more?

  42. Totally agree, anonymous!
    At 49, your friend has earned her time on bedrest.

    Be the change you want to see in the world.

    I wanted to stay home with my daughter, so I'm doing it.

    If I had to hire an employee, I would certainly consider the best candidate and would be happy to hire a woman of childbearing age.

    My physician group tried to recruit me to join full-time (with all the benefits and payouts) by voting through 17 weeks of privately-funded maternity leave. I ended up not taking it because 17 weeks wasn't enough for me. But I consider it my legacy to future women who want to have a family and a medical career at my hospital.

    Change IS happening, if you make it happen.

  43. I will never understand why people are so aggresive to each other. Mothers who are against maternity leave policy is just something that escapes me. I doubt there will be a time in this country when anyone will get a year off post-partum with minimal pay and job security. Yet, so many women who plan their own maternity now feel threatened. Our taxes already support a ton of things most of us personally do not use - SS, food stamps, subsidized housing, etc. Kelley, do you think someone who lives off of food stamps and subsidized housing and not doing anything for themselves to earn their own living is more deserving than a woman who takes 3 months off? It seems to be part of capitalistic society - people only care about their own personal situation now, and are very short sighted, narrow minded. Great nation for politicians to be making laws that benefit themselves, not people. Society that does not invest in future generation looses. Unfortunately, that is what we are seeing now in US, which is loosing its leading position.

  44. Does Kelley believe people who live off of food stamps, subsidized housing for years, and not doing anything to improve their situation are more deserving of financial aid than working mothers who will take a few months off and return to work?

  45. I'm in Canada and my coworkers are 92% men. Our last hire is a woman of child rearing age. While it is true a woman is likely to take a year off after having a child it is not a given. The maternity benefits are not a year, most of that time is parental benefit which can be shared between the mother and father. Not very many men take much of it but they are entitled. Further maternity/parental benefits are part of our unemployment insurance that all workers pay for monthly, so this is not a 'free' benefit. You have to contribute for a minimum period before you can make a claim.

    The most significant effect of an extended leave at my workplace is covering for the absent employee. This sometimes goes smoothly and sometimes not. It has been women that have taken leave following childbirth however many men have taken extended medical leave following injuries or surgeries. These absenses have been just as disruptive to others.

    Do I believe that in Canada a person might not be hired because they might have a baby? Well, probably. Do I know anyone who even suspects this happened to them or someone they know? No. Do I think it is a common problem? Absolutely not. They also say better looking people get hired over less attractive people, and that I have seen happen.


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