The stretcher was wheeled into the operating room.  I had been in this room on three prior occasions, under very different circumstances. But today, as I lay flat on the table, listening to the small talk around me, I tried to breathe against the weight of the baby and the pressure of the procedure.  My husband will later tell me it happened so quickly, but for me, time stood still until I heard the crying.  A reassuring sound.  A healthy baby girl.  After settling into the world, they brought her over for me to admire.  My reaction was the same as with our first daughter; I vomited.  So much for the glamor of childbirth.

The first few days were a blur.  My husband was home for a week.  His paternity leave/week of “vacation.”  The nights were longer than we had remembered, but despite our struggle, our little girl was thriving, and her sister was slowly adjusting.  Like that we were a happy family of four.

When my husband returned to work the following week, I settled into a routine.  Although not exciting, I was thankful to have this time to bond with my daughter.  To concentrate on breastfeeding.  To learn how to be a mother of 2 as my husband was rewarded with multiple call nights upon his return from “vacation.”  It was hard to determine who was more exhausted.

Days passed, the holidays came and went, and suddenly I became acutely aware of my 12 weeks of leave.  Almost double that of my first child, and paid, a luxury the second time around. But I counted the weeks.  As the weeks that had passed outnumbered the weeks I had left, I began to start planning.  Pumping sessions were added to my days, and a bottle was introduced to prevent the hunger strike her sister had pursued and its associated guilt; although I knew the guilt was unavoidable regardless.

As a working mother, I am no stranger to guilt.  I had felt a mixture of excitement and guilt since learning I was pregnant with our second child.  Leading up to maternity leave, I packed my clinics and added extra OR days to avoid disappointing my patients and leaving additional work for my partners.  When discussing my impending leave with my partners, one had expressed their desire to walk away from work for 12 weeks for maternity leave. I doubt they were referring to the sleepless nights and hours of breastfeeding ahead of me, but I found this comment enlightening.  I understood at that moment the root of the issue.  For some, maternity leave was viewed as a form of vacation rather than the vital period of bonding between a newborn and their parent.

This sentiment began to creep its way into my 12 weeks.  Emails from colleagues.  Requests to contact my patients, to attend a faculty retreat, or to complete research projects.  Despite my best efforts to ignore these emails, the guilt would creep back in.  As the baby slept in her swing, I completed a chart review rather than holding her as she slept.  I worried about my patients when the emails came in.  I wondered if they would wait for my return or find more accessible providers.  I counted the passing weeks.  Without avail, I tried to ignore the job I would be returning to shortly.

How do women walk out of the office for maternity leave and truly not return until they have taken the time to physically and emotionally heal?  How do they ignore their inbox or better yet, how can we get their colleagues to not litter their inbox with requests?  A nationwide maternity leave policy?  This would unlikely cure the guilt and anxiety of the working mother, but perhaps it would address the underlying vacation sentiment.  If the nation treated maternity leave seriously, would everyone?  Myself included.  Would I stop pretending I was happy to complete research and answer emails?  Stop pretending it was OK that my precious and limited time with my newborn is interrupted by work.  Stop pretending that all has returned to normal, when in fact, I am overwhelmed and exhausted.  I don’t know the answers to these questions, but I do understand the importance of this conversation.

The hope being that this conversation will result in policy change.  This need for change was recently highlighted in an article published in Forbes in April 2016.  The title, “U.S. dead last among developed countries when it comes to paid maternity leave” says it all.  According to this article, Papua New Guinea is the only other country not to guarantee paid leave.  This is despite the evidence that paid maternity leave is linked to improved health for mothers and babies; has been linked to lower rates of postpartum depression, lower rates of newborn and infant mortality, and higher rates of breastfeeding.  The CDC has found that employed woman with 12 or more weeks of paid leave are more likely to start breastfeeding and to continue this for at least six months.  Although the evidence is there, the action has been slow.  California has passed the California Paid Family Leave Act requiring at least partial pay and New York will start a similar program in the years to come.  Although promising, a slow start.

As I write this article, I am aware of how fortunate I am to have 12 weeks of paid maternity leave, but I am also aware of how different this feels from my first maternity leave.  Like so many new mothers, I was faced with the less than ideal scenario of bringing my 8-week old infant to daycare, so that I could return to work and earn a paycheck.  The number of women who face similar challenges is endless, but perhaps with more conversation, we can find change.

Amy Hughes is a pediatric otolaryngologist.

Image credit: Shutterstock.com