Bye baby boy
mama has to work.
Let me hug you once more,
see you in 12 hours.
Bye baby boy
don't look so forlorn.
In between patients
you are a constant on my mind.
I think of holding you close,
imagine your smile.
Bye baby boy
sorry that I can't feed you.
At work
my full tender breasts
are a constant reminder.
Bye baby boy
you are growing up so fast.
Last week
I saw videos of you
crawling,
sitting for the first time.
Bye baby boy
time to say goodbye,
before I close the door
look at you once more,
see you in 12 hours.

I wrote this poem during an ICU rotation of my internal medicine residency training. At the time, I felt as though I was balancing on a fine tightrope, navigating the joys and physical scars of being a new mother, the rigorous hours of residency, and applying to cardiology fellowship programs. During my final trimester, I remember the countdown to delivery; it was not in weeks as is the usual experience, but rather in rotation blocks: night float, clinic, ED, night float, clinic, and finally one month of medicine floors, and all the while, my husband and I were navigating a long-distance relationship between New York City and Chicago.

Life suddenly changes with a new baby. You acquire new skills – changing diapers, pumping, and rendezvousing with a wide-awake baby in the wee hours of the morning. Residency, pregnancy, and motherhood is a delicate balancing act, which is hardly perfect.

My physicist mother-in-law left the comfort of her Florida home to camp in my shoebox Manhattan apartment to support me. My colleagues, most of whom lived in the same resident housing, were a source of encouragement. I relied on that tapestry of support.

Oceans away and decades earlier in Bangladesh, my mother navigated a similar path of internal medicine and subsequently motherhood during interventional cardiology training. My mother had long hours. My grandmother was my primary caretaker, and for years I called her 'mother.' I draw parallels to how my mother-in-law has looked after my son. In South Asian countries the joint-family concept is common, the tapestry of support is often ready and waiting. The extended family is already under one roof, and you don't have to weave your own tapestry from scratch.

I grew up in a house wrapped in pink bougainvillea on one of the narrower streets of Dhaka. It was a joint-family home with my grandmother as the efficient general ensuring the proper functioning of the 20-member household. There was structure and balance amongst the crazy mayhem, and thankfully I grew up surrounded by family.

My son is now three years old, and I am in my third year of cardiology fellowship, about to embark on an interventional cardiology fellowship next year. I often find myself reflecting on the pregnancy experiences of my mother and I, in Bangladesh and the U.S., and how the maternity leave landscape affects women in medicine, including women pursuing specialties such as cardiology and its procedural sub-specialties.

I was lucky to have such supportive leadership during my residency. I recall feeling fearful and guilty when faced with telling my chief resident about my pregnancy. I now laugh when I recall telling him, "I am pregnant, and I think I will need a few days off after giving birth." He looked at me, shocked and confused, "Mariam, congratulations! A few days off?! Now, by NYC law, you can get up to 6 weeks maternity leave. We will figure it out." The guilt and fear of being a burden rapidly dissolved. I am forever grateful for the support and kindness of my colleagues.

Six weeks after delivery I was back in the CCU. In my head, I had naively thought that 6 weeks was a long time. It isn't, and now, with the benefit of hindsight, I realize it wasn't. In a recent study of physician mothers, only 26.7% of first-time mothers felt the time off was adequate and the majority desired more leave time, ideally 4 to 6 months.¹

The maternity leave system in the U.S. is complex. At the federal level, the Family and Medical Leave Act (FMLA) allows up to 12 weeks of job-protected leave per year, which includes caring for a new child. However, this leave is unpaid.² At the state level, seven states currently have publicly funded paid maternity leave: California, New Jersey, Rhode Island, New York, Washington, Massachusetts, and Washington, DC. But even then, pay is often capped. In New York, paid family leave in 2022 will be capped at 67% of the current Statewide Average Weekly Wage ($1,594.57), meaning a maximum weekly benefit of $1,068.36.³ In most states without publicly funded maternity leave, families tend to rely on short-term or long-term disability insurance provided by employers. Is pregnancy a disability?

Contrast this with Bangladesh, where the government sector provides 6 months of paid maternity leave while the private sector provides 4 months of paid and 2 months of additional unpaid leave. On paper, this may seem more favorable than the U.S., however, it is unclear the extent to which these regulations are practiced. For instance, the World Bank ranks Bangladesh low on several indicators concerning women's employment during and after pregnancy, with room for improvement in maternity leave benefits, paternity leave, and prohibiting the dismissal of pregnant workers.⁴

As an international medical graduate and Bangladeshi woman, I finally feel that I have roots in the U.S. since the birth of my son. This is now my home. As a physician and mother, I know we can do better, not only in the U.S. but globally, in providing better support to new mothers and growing families. Maternity leave is a human right. It is a simple truth that is often overlooked. I am not sure what the answer is, but I think the first step is to further this dialogue, especially among the medical community. There are many more stories like mine. This is my effort to add my story to the conversation.

References

1. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2752815
2. https://www.dol.gov/agencies/whd/fmla
3. https://paidfamilyleave.ny.gov/2022
4. https://wbl.worldbank.org/content/dam/documents/wbl/2021/snapshots/Bangladesh.pdf

This article was authored by Mariam Khandaker, MD, PGY-6 cardiology fellow at the University of Miami/Jackson Memorial Hospital. @KhandakerMariam