The First 24

I am going to write about something that most working mothers don’t talk about, but many have experienced… maternity leave. I want to talk about this because many of you reading will likely have a partner who goes on maternity leave. If you want to make her feel valued as a member of your team, realize you can do something. I think how we treat our new parent colleagues, especially the first 24 hours back from maternity or paternity leave, speaks volume to the culture we create.


I have four children. I had my first during my first week of internship, second during my third year of residency, third during an executive fellowship, and last while starting my academic career. There is never an “easy” time to have a child when you are a physician. The timing of each pregnancy presented its own challenges. I had different lengths of maternity leave for each child, depending on my training and years in practice. One was only 4 weeks (I honestly have amnesia for that period of my zombie life) and the rest were 6 to 10 weeks.


When you are a physician, you can’t put up an “out of office” sign for weeks at a time. Someone else has to see your patients and take your call during your maternity leave. I chose a specialty where patients need care 24/7, and thus we take 24-hour call. When I was on each of my maternity leaves, my call was covered by my partners. We had equal call requirements over the year, which meant before my maternity leave I needed to take extra, and after my maternity leave I had to make up any calls I owed before each child was born. This allowed me, as a new physician, to avoid financial penalties that would have occurred when I chose to have a baby. 


But it meant while pregnant and after coming back from maternity leave, I had to work longer hours to compensate for my absence. I always tried to work my extra call hours when I was pregnant. I banked my hours waddling around so I would not have so many to make up when I returned as a new mom. There is no such thing as “lighter” physician work. Patients are sick, surgeries must be done, and you must do the same work day in and day out.


The hardest thing for me about each of my pregnancies as a physician was the following:


1.     Guilt for leaving my partners on maternity leave

2.     Guilt for leaving my child when I returned to work


A recent study by Eleni Linos, MD and colleagues published in JAMA of close to 6.000 women physicians reported that 66% reported gender discrimination in the workplace, while 38% reported discrimination specific to pregnancy, maternity leave, or breastfeeding. Female physicians in my specialty, anesthesiology, reported some of the highest rates of discrimination for being a mother in the workplace. My colleagues and I recently reviewed this article and discussed this finding. None of us were surprised.


Anesthesiologists have little control over our workday schedules. When parental duties (breast feeding/pumping, doctor appointments, child day care emergencies or programs) arise, we cannot just schedule a gap between patients, work over lunch break, or stay late to make up our work. We have to ask one of our partners to physically stand in our gap, whether it’s a 20-minute pump break or a two-hour childcare emergency. It is stressful to ask our partners to help us out and most of us avoid it at all costs. Physician burnout is real, and the last thing we want to do is off load our work onto one of our partners and perpetuate burnout.


Even though I took the same amount of call as my partners all year, I still felt immense guilt for my absence. When I came back to work, several of my male partners would say, “Hey! How was your vacation?“ or “How was your sabbatical?” While some of them were teasing, comparing maternity leave to vacation or a sabbatical can only be done by someone who has never been responsible for q 2 hours feedings night after night, weeks at time.


The truth is, I was responsible for several things in my department, and some things I couldn’t leave for weeks while caring for a newborn. I worked during every single one of my maternity leaves. While I’m not advocating this, is it the truth. I read manuscripts during 2 am feedings. I reviewed emails and echocardiograms during 4 am colic attacks… the only thing to get my child to hush was me rocking them, so hey, why not?


I am fairly certain my colleagues would not refer those days as “vacation”.


With three of my four children, I was on call my first day back to work. This was rather common in the call model I was in, as it allowed us to make up our call and avoid a financial hit.


The first 24 hours are miserable.


Think about it:  mothers spend 24 hours a day for 6-12 weeks feeding, holding, bathing, and being the lifeline for a helpless human being. We are her nurse, his guard, her breath. We calm her, dress her, clean him, move him, exercise her, and even support his head. This little person is 100% dependent on another person for life, and for the majority of our maternity leave, that person is us.


Then one day, you pack your bag, throw on your white coat or scrubs, and leave them for 24 hours.


It. Is. Heart. Breaking.


If you are a mom who has done this, you know that mixture of complete sadness, worry, grief, anxiety and guilt.


Every mother experiences this when she returns to work.


What helps?


I had a few partners, male and female, who would check in. How are you doing Sash? How is the baby? Are you getting sleep? A few of my female partners would check to see if I needed anything like a pump break. I can’t tell you how much I appreciated those women. They were basically saying, “We know it’s hard, hang in there.” They understood, because they had been there.


I am so thankful for the colleagues, men and women, who cheered me on during those rough times. I am thankful for those who understood when I needed a break from the OR to make a quick phone call home during a long call and check in. While my maternity leaves are joyfully in the past, I try to pay it forward and be that partner to women I see making the transition back to work.


Let’s take care of one another in healthcare and appreciate our working parents – both men and women alike. I am grateful for those who looked out for me.


#heforshe #sheforhe #resilience #workingmoms #physicianmoms #physicianpartners