As we saw in part one of our series on managing maternity care physicians need to be prepared to successfully navigate the twists and turns of pregnancy and parental leave while in residency or practice. Certainly, the same is true after the baby arrives, when a new set of issues must be addressed. A few issues that are likely foremost in new parents’ minds are the length of time they will be able to spend at home with a child before returning to work, what they will do about childcare when they are not at home, and how they will handle all of the unpredictable—yet inevitable—situations that can arise when juggling family and career.
Explore this issue:May 2017
The passage of the Family and Medical Leave Act (FMLA) in 1993 made it possible for many parents to spend up to 12 weeks at home with their new child without worrying about loss of employment. Twelve weeks can go by quickly, however, especially if a portion of that leave was used to nurse a high-risk pregnancy. What happens after that depends on a series of variables that, hopefully, new parents have worked through in the weeks and months preceding the birth.
When a new mother returns to work, she generally has two major concerns that require immediate attention: breastfeeding (if, where, and how) and childcare. And she has reason to be concerned: In June 2016, the Journal of the American College of Surgeons published the results of a survey of general surgery residency program directors on matters of pregnancy and parenthood among their employees. Among the respondents, only slightly more than half (58%) reported the availability of lactation space, and only 38% reported the availability of on-site childcare at their facilities (J Am Coll Surg. 2016;222:1090–1096). (See “A Room to Nurse,” below.)
The need for on-site childcare in hospitals was officially broached in 1983, when the Journal of the American Medical Association published an article entitled “Hospitals Should Provide Day-Care for Children of Employees,” in which the authors contended that such services would improve productivity, decrease turnover, and aid in recruitment (JAMA. 1983;249:2090–2091). Some 35 years later, that argument has proven to be true for the well-established medical institutions that usually lead the pack in published lists of “the best hospitals in which to work.” One such hospital is Christiana Care Health System in Wilmington, Del., which offers: lactation rooms for breast-feeding mothers along with support services that include counseling, pumps and refrigeration; an onsite childcare center; and a dependent care account to help cover childcare expenses for children under age 13.