Thursday, May 8, 2014

Question: Maternity leave

Lately every night I'm on call I seem to be the magnet for pregnant patients - trauma, acute abdomens, appys, choleys - you name it.  During my last call as we talked about my pregnancy magnet, it lead to a discussion about having babies during residency.  We happened to be a diverse group of providers with a diverse and international training background. The take away from the discussion was basically that in the US we don't value new moms, dads or babies.  Those who had trained elsewhere (in surgery) seemed to feel that it was just natural to expect residents to take 4 months, 6 months, or 1 year off (mom or dad).  Meanwhile we all told stories of post c-section residents NSAIDing their way through full operative days 4 weeks after giving birth.  We talked about how broken your body can feel so soon after giving birth, both mentally and physically.  We talked about those itty bitty 6-week old babies in daycare.

So, for those of you who have trained elsewhere in the world:  
What is the attitude towards new moms and dads in other countries with more flexible and lengthy maternity leave policies? 
Are residents looked down upon for taking leave (like they often are in the US)?  
Does a culture of more family centric leave create a more equitable distribution of gender roles in the home and the workplace? 

I'm just wondering...

27 comments:

  1. I'll add a counterpount: I felt a lot of pressure to take MORE time off. Everyone talks, judgementally, about those "itty bitty 6-week old babies in daycare." But taking care of a nonverbal, nonambulatory baby is NOT my calling in life. I AM a great doctor and I do want to do that full time and staying home with my daughter while my husband worked by the end of 6 weeks was threatening to cause a gender war in our house.
    I think the expectation is that you will feel so sad and so bad to go back at 6 weeks and that's incredibly undermining to professional women.

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    1. Thank you. http://nicoleandmaggie.wordpress.com/2013/03/06/unnatural-mother/

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    2. Larval Doctor, I agree with you as well. Even in the US, I got a lot of disapproving looks for leaving my poor baby in daycare. I think that we should be free to choose without judgement. The problem with only 6 weeks is that it is so restrictive. Some may not emotionally be able to return, but many may not physically be able to return to full work responsibility. If you had to take any time off at any point during the academic year prior to delivery, you could be left with only 3 or 4 weeks of actual maternity leave during residency.

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    3. Thank you for this LD. I wish there was more flexibility in the US so that families could take the amount of leave that was appropriate for THEM. I also wanted to get back to work quickly, both for my sanity and for professional reasons (didn't want to delay graduation for another year), and every time I chime in with this perspective people tell me that I am being anti-woman and that I am a bad mother. What I really want is for my husband to be able to take more than one week of paternity leave!

      And Cutter, I received similar comments when I put my daughter in daycare. It is also a pet peeve of mine when people say that it's ok for mom to work as long as a family member is available to provide childcare. What about those of us who don't have someone who can do this? Are we committing child abuse by having a nanny drop our kids off at daycare?

      The problem with 6 weeks is that it is a one size fits all approach, and not all births and babies are simple. And also, the sleep deprivation you can still be experiencing at home when your baby is 6 weeks old can be pretty brutal. I know doctors aren't supposed to need sleep, but... being impaired because of sleep deprivation is just a fact for the parents of some newborns.

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  2. I am a Canadian resident currently expecting my first child and so this topic seems very close to home.
    I have been thinking a lot about how much time to take off and its not an easy decision. Most residents take at least 3 months and up to a year. If I take more than 6 months I essentially add a year to my training schedule. The average seems to be about 6 months but I'm not sure that will be enough for me. My mother (who only got 6 weeks) has been trying to get me take a year. At the moment I have scheduled 8 months but that will be a little bit flexible. The usual response when people ask me is mild surprise "oh! good for you!" I think because it is longer than they expect. But I understand that this will extend my training - but I've been at it for 12 years! Are we really discussing a few more months with my baby? Having said that, everyone so far has been very supportive (except the chief resident when he was making the summer call schedule but that is a whole other kettle of fish...)

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  3. Another canadian resident here. I am currently pregnant with my second child. I took 6 months off for my first one, and plan to take another 6 months for this one, thus delaying my graduation by a complete year. Most residents here take between 3 to 10 months of maternity leave, but you can take up to a full year.
    We are not looked down upon for taking such a leave, but some comments are definitely made when the call schedule is made (no call after 20 weeks pregnancy). But usually people are very kind and respectful.

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    1. No call after 20 weeks? Wow! Is that how things work in the "real world" after residency, too? I have a partner who is 38 weeks and still taking call. In the US they have all these restrictions on call and post call in residency, but they also don't apply to the real world.

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    2. I'm an attending in the US and currently 38+5 wks with #3- this is my last call wknd :-) until after my partially-paid 3mo maternity leave. I took 6 wks and 8 wks mat leave after my first two babies...

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  4. My problem with the maternity leave in the US is that it is one size must fit all. My friend, who went to a different residency program said women were pressured to return to work 3-4 weeks post-partum. One of my good friends returned after 2 weeks, because otherwise she wouldn't be able to start fellowship on time and had the potential to lose the position. I took 6 weeks off, but then had no vacation or sick days left the rest of residency.

    I think we need to be supportive of women taking the time they feel they need. There are women who can't wait to get back to work, and we should have better access to daycares and other care providers to help make that possible. And there are women who would love more time at home, and there is no system in place to allow that to happen. I've always been envious of my Canadian counterparts that could take such an extended maternity leave.

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    1. Great point about improved access to daycare and care providers. The options for someone working the hours of a resident are so limited. Also, few hospitals have in house child care option and few have any type of child care support.

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  5. Wow, I'm shocked to hear what our Canadian counterparts are saying--maybe I should move to Canada!! In the state which I live, we are legally allowed 12 weeks without losing our position, but it was made clear to me that more than 6 weeks off would be frowned upon. I took 24 hour calls up until the day I went into labor. I was at a doctor's appointment post-call when she told me I may have to go in later that day. I actually didn't end up having the baby until the next day, but still. I remember thinking, "Ugh, but I barely slept last night, I really could use a night of sleep before going into labor..."

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  7. I certainly agree one size doesn't fit all! I'm Canadian and know Moms who went back after three weeks because they wanted to, or took off up to a whole year. My three were born in med school and residency and my leaves were six weeks, one year, and seven months, respectively.

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  8. I'm Canadian and was pregnant mid-way through my Urology residency. Our residency organization states that residents should not be on-call after 31 weeks. Our institution allows for up to 3 months off for maternity leave without owing more time afterwards, depending on the discretion of the program. My program had no idea how to deal with a pregnant resident (I was the first pregnant resident and fourth-ever female resident).

    However, many of my non-urology peers took a whole year off (even surgical residents). I ended up taking 2 months off, followed by a one-month research elective and came back. My husband took essentially 9 months off and we put our baby into daycare at 9 months (before she developed stranger anxiety). Now I'm in my chief year. I have zero regrets because I'm finishing with my peers and VERY eager to move on!!

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  9. I'm an Australian ObGyn resident expecting number 2. I took 9 months for #1, costing me 12 months training and will take about 6 months for #2. Our system is very flexible and it is expected that you can take time if you want it. The shortest maternity leave I've heard of is 10 weeks. Training here is different though - we are paid well, have "safe working hours" guidelines, are usually 3-4 years post grad before we can start specialist training (6 years) and often don't finish training until 10 -12 years post grad.

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  11. Do hospitals in Canada rely on residents as the primary provider of hospital labor? My understanding is that this is why residents in the US are pressured to take so little maternity leave. Who covers the work when residents take 6 months of leave in Canada?

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    1. Yes, absolutely. At our hospital, very few services have nurse practitioners (ortho, neurosurg, cardiac surg) who help run the floors but I don't think they are utilized to the degree that they are in the US. In Urology, we are expected to cover all the clinics, inpatient care, consultations, ORs and call. None of our off-service residents take call.

      A major difference is that although we have post-call guidelines, I don't think they are reinforced as strictly in Canada. Our provincial resident organization has post-call guidelines that you should go home after handover but many surgical residents when they are on-service are still in hospital post-call.

      Any thoughts from other Canadians?

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  12. How does one go about changing the " one size fits all" model to allow more flexibility in the US??

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  13. This post could not be more timely for me. I'm a med student and I graduate in 10 days and I'm scheduled to have my first child delivered by C-section the very next day. I'm looking forward to starting my residency in psychiatry and had been trying to work with the department to find out what options I had re: maternity leave. Initially I was told that as an employee, I'd be entitled to 6 weeks of leave. I don't start orientation until 3 weeks after my baby is born, so during that time I consider myself a regular person not affiliated with my program, school, etc. Then they get back to me last week to say that they're going to count the 6 weeks starting from the day my baby is born which will include those "free" 3 weeks I previously mentioned. That works out to essentially me getting 3 weeks of actual maternal leave. To add insult to injury, they told me that I will be required to come in to most of the orientation days, which is robbing me further of 2 of those remaining 3 weeks I thought I was getting. That means that I really am getting one true week of maternity leave before I'm expected to start.

    I'm so angered because I don't understand how they think they can shaft me of my maternity leave like that after initially appearing to try to be flexible. Also, how it it fair to grant me any type of leave but require me to show up to work-related things during that time?! I feel caught between a rock and a hard place because I want to push the issue and not feel shafted but at the same time I don't want to come off as being difficult, especially at the start of my residency training.

    Is this typical and what I should expect during residency?

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  14. Raven - that sounds draconian and possibly illegal. I would investigate your options with Human Resources and if that doesn't help, find a lawyer. FMLA is a national standard in the US and applied to my maternity leave (in residency). Your program may require you to make time up that you miss, since it is time taken from your training, but they cannot force you to come back that early.

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    1. Thanks Zelda and Jay. I think I'm going to contact the incoming chief resident to ask her to point me in the direction of the right administrative department. Apparently at my institution, my program is a weird hybrid between the university and the hospital so I'm not entirely sure which HR I should consult. For some reason my program has not clarified details like this and it seems like they're waiting until orientation to make this information available to us...

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    2. My hospital is also a hybrid, go through the GME office.

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    3. You are not eligible for FMLA unless you have worked for your employer for at least 1 year as a full time employee. The ACGME also has VERY strict rules about how much time you are allowed to take off without making up any time. When I had my baby during residency, I had 2 weeks vacation time for my leave, 4 weeks that I had to do a reading cush rotation, and then 2 weeks that I had to make up at the end of residency. I also had to do continuity clinic by my third week post-partum (and post-C section). A lot of these rules are ACGME related, so they can't be circumvented. But if you're willing to make up time at the end of residency you'll have more flexibility.

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  15. Nor can they dock you for time taken before you are an employee. If it were any job other than residency, I'd suggest you walk. Since it's residency...do what Zelda said, including the lawyer.

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  16. Yesterday this article called, "US 'losing out' over paid maternity leave" was posted.

    http://news.msn.com/us/us-losing-out-over-paid-maternity-leave-un

    Apparently, the US, Papua New Guinea, and Oman are the only 3 countries within the UN that do not require maternity leave to pay any percentage of the salary as long as time off is given.
    Some "world leader" the US is becoming.

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  17. Hi there. I am writing as a Canadian mother of three. I had all three of my babies in graduate school. Now granted, forgive me, I am not an MD. But I did my clinical in hospital. We are lucky in Canada -- I was given the option of a full year maternity "leave" from my graduate level program for each of my pregnancies. This is in keeping with the human rights policy of my university and is reflective of the one year paid maternity leave given to working women (and men) here in Canada. When I was born (in the 70s), my mother was doing her MD residency, so I have read this site with great interest. Looks like not much has changed in 40 years as far as flexibility for pregnant residents goes. Thank you for permitting me to post.

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