New parenthood and the realities of returning to work shortly after giving birth are topics we don't talk about much in their ugly details. In this election year — maybe for the first-time ever — family leave is an issue politicians on both sides of the aisle are discussing. We hear from conservative leaders that we can't afford a national paid leave program, despite national and state-level evidence to the contrary. What we don't hear about are the high costs new parents are already paying. We don't talk about postpartum pain — bleeding, stitches, not being able to stand upright, or easily walk around. We don't talk about the struggles of early breastfeeding: cracked and bleeding nipples, mastitis, and worries about producing enough milk. We are only beginning to talk about postpartum depression and anxiety. And it almost seems as if new fathers and adoptive parents don’t matter at all. The rhetoric from those who don’t want change paint a rosy picture of motherhood, but the realities of these anti-family policies are much more grim. In a recent TED talk, I share a number of heart-wrenching personal stories from women who have suffered as a result of having to return to work too soon.
We don't talk about the struggles of early breastfeeding: cracked and bleeding nipples.
The U.S. is the only developed nation in the world that does not mandate paid leave for all new mothers. As a result, the vast majority of women — some reports say 88% — get no paid leave at all, and almost a quarter of new mothers are back on the job within two weeks of giving birth. Women are now 47% of the American workforce, and this once niche problem is becoming an epidemic. This week marks the 23rd anniversary of The Family and Medical Leave Act. FMLA is the imperfect federal law which provides workers with 12 weeks unpaid leave, but only if they fulfill all the requirements: employed full-time for at least 12 months for a company that has 50 or more employees, within 75 miles of the employee’s workplace. These requirements create a situation in which half of new mothers are ineligible for FMLA. It’s no wonder that so many parents are returning to work before they are ready — many have no choice if they want to pay their bills, as well as keep their jobs and health insurance. But it isn’t just political leaders who are perpetuating the marginalization of a new family’s needs. Sometimes, even medical professional get it wrong. Ahead, in a powerful open letter, one Ob/Gyn offers an apology to a new mother she saw decades ago. This doctor is still haunted by the memory of how she quickly dismissed the needs of a new mother and baby. The experience forever changed the way she looks at new parents and the importance of parental leave.
Dear Postpartum Patient, About 20 years ago, most likely in the fall of 1995, you came to me for a checkup following your C-section. I was a young resident and it was one of my first clinics. You asked me to extend your disability to eight weeks (instead of the customary six weeks) because of your C-section delivery. You didn’t look “disabled” to me, so I told you no, that six weeks would be adequate to recover from your C-section. I’m sure I did a pap smear and sent you on your way with a plan for contraception. Fast-forward 20 years. Now I know that women who return to work too soon (yes, I now realize that six weeks is too soon!) are at risk for postpartum mood disorders. But back then, I didn’t ask how you were doing emotionally. I didn’t ask you what type of work you do. I didn’t ask if you were breastfeeding. Those details seemed irrelevant me. My heart breaks years later, as I write this letter of apology. I am so sorry that I didn’t extend the empathy that I feel now. If you were trying to breastfeed after your return to work, I am sure I made it nearly impossible for you to reach the goals you may have had. When I saw you, I didn’t have much life experience outside of the hospital.
You didn’t look “disabled” to me, so I told you no.
Just two years later, I had a baby, and just five-and-a-half weeks of maternity leave. I struggled greatly. I spent the first two weeks trying to breastfeed, recover from mastitis, and then formula feed a baby who then turned out to be allergic to cow’s milk. I decided to relactate during my last week of leave because I couldn’t stand seeing my baby cry so much. I spent that final week breastfeeding, pumping, and washing pump parts around the clock. Once I was back at work, I missed my baby so much. I was miserable. I finally realized how uneducated I was about the postpartum period. I was horrified thinking back to how I had treated you. I am so appreciative of the women who supported me through that time, many of them were women who had also suffered. But some of the women had profound empathy for me, without having had any personal experiences with new motherhood. I wish that I could apologize to you in person. I know you were working hard to do the best you could for your family, and I am sure you are a wonderful mother. As your healthcare provider, I am sorry I wasn’t there for you when you needed my support. You deserved so much more from me than the meager eight weeks of disability you were requesting. You deserved my attention. Please know that my treatment of you back then has motivated me to be a better physician to postpartum women. I serve on The American Congress of Obstetricians and Gynecologists’ District IX Legislative Committee, where I have advocated (successfully) for California legislation for lactation rooms in airports, support of teenage moms who are breastfeeding and returning to school, and breastfeeding supportive hospital practices. I run an informal program at Stanford for new parent physicians who need additional support when they return to work. I consider it a medical and ethical mandate for me to do whatever I can to advocate for new mothers and their very real needs. I will advocate for the rest of my career for women and families to have the support and paid leave that all families deserve. Sincerely, Susan Crowe, MD, FACOG Susan Crowe is a Clinical Associate Professor, Department of Obstetrics and Gynecology at the Stanford University School of Medicine.