Wellness and Healthy Living: BJC Medical Group


Published on Monday, July 21, 2014

Out of Office: What’s the Right Amount of Maternity Leave?

Rosanna Gray-Swain, MD, (Ob/gyn)

Motherhood brings many challenges to a woman’s life. One of the first challenges for working moms to figure out is how long to take off from work after giving birth. I get this question almost daily; and it is a question that comes with much angst for many women. This is a very complex and personal question with no perfect answer.

The Unites States is not known for its generous support of maternity leave; in fact, we have no national policy on it and have one of the weakest maternity leave records amongst first world countries. This is the result of a complex social, political and financial climate.

When will my body heal?

To begin the discussion about the ‘best’ amount of time a woman should take off, we have to consider the physical time needed to recover from the birth. This will be longer if there was a medical complication or cesarean birth. Your doctor can easily tell you when your blood pressure is stable, your stitches are healed, your anemia has improved and your muscles are strong enough to return to work. Medically, most women are cleared to return to work at six weeks. That is the easy part.

When will I be emotionally ready?

What your doctor can’t tell you is when it is the right time to leave your child with someone other than mom for many hours of the day. My view is that the social and emotional needs almost always take longer; and this is the much harder component to define.

For some families, the answer is not until the child goes to pre-school, and for others, it is very soon after delivery. The factors that go into this decision are often a combination of financial needs, personal desires and cultural expectations.

Can I afford it?

In an era where two-thirds of women work, it is more and more common that the woman’s financial contribution to the household is substantial, placing greater importance on her quick return to work. Whether or not this is a good thing can generate a healthy debate, but it is the current environment in which we live, and there is nothing to suggest a change in this trend in the future. So, how do we answer the daily question of “How long do I take off?” or “How long should my wife take off work”?

I like to start off the harder part of the conversation by asking a mom ‘If money were not the issue, how long would you like to take off?”. The answer to this varies a lot between women and cultures. Some women really do not enjoy the first few months of infanthood, do not intend to breastfeed and want to bank time off for later when the baby is more interactive. Other moms find the first few months to be a time of magical bonding. Some moms feel so overwhelmed by the first few months they don’t even know what they feel!

Once I get a sense of a mom’s personal desires about staying home, we then start to talk about the financial realities. Sometimes mothers can take advantage of any paid FMLA or other forms of insurance that would allow her to stay home and be paid for a period of time. We also talk about who is going to watch the baby when she returns to work and the cost of that.

What about breastfeeding?

During this conversation, we talk about breastfeeding plans. I encourage all my patients to breastfeed; we know it is best for mom and baby. The American Academy of Pediatrics recommends breastfeeding for the first year. Having sufficient time with the baby to establish a good milk supply in the first few weeks and months is critical for most women’s success, especially with the first baby.

Although many moms are successful, it is a true challenge to work and breastfeed. You must either have someone bring you the baby to nurse at work (which is not an option for most childcare situations), or you need a breast pump AND a peaceful, clean place to pump. Ideally, you need the time to pump every 2 to 4 hours. Many, if not most, employers do not offer a reasonable place for a mom to pump; this is especially true for our workers at fast food chains, gas stations or discounts stores.

Unfortunately, our modern American society is not designed to support breastfeeding, especially not breastfeeding at the work place. I am lucky that I have an office to pump in, and there is a designated pumping room in the hospital where I operate, but I know I would not have been successful if I had a job where these amenities were not available to me.

So it is true, breastfeeding success can change the ease and rapidity with which women can return to work, and we discuss how to balance these factors on an individual basis. Many women struggle with the feeling that they are choosing work over their baby’s best interest when the work environment does not support successful breastfeeding. It is important that we offer breastfeeding support in a way that does not exaggerate this guilt, and remind moms that what they are doing is very hard. We need to remind moms that any breastfeeding is better than none. Even if they have to supplement with a portion of formula after going back to work, they are still doing a great job by providing whatever portion of breast milk that they can.

The decision is yours

Although I occasionally have women who call and are ready to return to work earlier than we had planned, I more often have women saying they feel unprepared to return to the workforce at six, eight or even twelve weeks. Sometimes, the breastfeeding issue is still working itself out. Sometimes, it is the emotional challenge of new motherhood and exhaustion, or simply that she has fallen in love with her little baby and wants to continue the journey’s natural path with her as the primary care giver.

These are hard conversations, and there are situations when the demands of her family structure require she go back regardless. In other situations, women may leave the work force permanently or temporarily. Just as there is no ONE right answer for these situations and how long a mom should take off work, it is unlikely that we are going to see a major change in the percentage of women that are juggling both motherhood and career. I hope that all of our families with working women in them will join voices and start to foster constructive conversations about the value of parenting. We can demand better maternity and paternity leave policies as well as better support for work place breastfeeding.

Rosanna Gray-Swain, MD, is a board-certified physician at West End Ob/Gyn. Dr. Gray-Swain is on staff at Barnes-Jewish Hospital.
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Categories: Ask the Doctor, Women's Health


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