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.
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.
In some cases, off-site childcare is an option. Los Angeles’ Cedars Sinai Medical Center chose a location two miles off campus in a family-friendly neighborhood for its Maple Bear Academy, which serves children of employees only and is open Monday through Friday, early morning to evening. The childcare center at Hoag Memorial Hospital Presbyterian in Newport Beach, Calif., has similar hours but is located on campus and is open to the local community as well as to employees.
For smaller hospitals and private medical practices, on-site childcare is the exception rather than the rule, a reality that can make working at these facilities less attractive to residents and physicians with growing families. In the absence of childcare support, many physicians opt to work part-time while their spouse works full-time, but this can often limit the ability to pursue a specialty or vie for a promotion.
What about Dad?
There’s no getting around it: In the U.S., the vast majority of working parents who require a steady income are obliged to spend large chunks of time away from their new babies. Having in-home care, especially if it is provided by a trusted family member or friend, seems like the next best thing to being there—especially if that caregiver happens to be the father.
“There’s an increasing push for fathers to be able to take time off at the time that a child is born or adopted,” said Kim Templeton, MD, past president of the American Medical Women’s Association (AMWA). Although FMLA provides for paternity leave, most states still do not provide paid family leave to mothers and fathers on an equal basis, however, and a 2012 U.S. Department of Labor study reported that only 13% of men who took parental leave received pay, compared with 21% of women. “There is still this mindset that women are rearing their children, while time spent by fathers with their children is ‘babysitting,’” Dr. Templeton added.
The fact remains that unless there’s a permanent stay-at-home loved one to care for your child, the need for professional childcare is unavoidable. “I tell people, ‘If you think your childcare is too expensive, you have to think of it as an investment,’” said Gayle Woodson, MD, a mother and an otolaryngologist at Ear, Nose, Throat and Plastic Surgery Associates in Winter, Fla. Dr. Woodson has relied on hired help to assist with her growing family for years. “You want somebody who can take really good care of your kids but can also do the housework so you can come home and be able to help with homework or read a story,” she said. “That’s my philosophy.”
Linda Kossoff is a freelance medical writer based in California.