Pregnant and in medical training? Here's how to do it.

We hear all the time that maternity leave in the U.S. is in shambles. Let’s clarify: There’s no such thing as guaranteed maternity leave. Some companies are obligated to give some leave to some employees — that’s as good as it gets. No companies are obligated to give paid leave.

Medical training adds complexity to parental leave. Residents and fellows are expected to be deferential, the lowest on the totem pole and privileged to receive training.

As a first time expecting mom, I approached requesting maternity leave from this same position — not understanding the varied priorities of those involved in determining my leave. I learned quickly after becoming a mom that maternity leave was not about me, it was about my child. I was accustomed to deferring for myself, but for my baby — that I could not swallow. Being a mom gave me a backbone. It gave me purpose. It made me so sad for all the other mommies and babies out there who haven’t gotten enough time to heal and bond.

I got a lot of mixed messages when I was pregnant with my daughter. Human resources would say one thing, program director another, Google another. I was so confused. I think everyone involved was confused. Now, I realize that there are different sets of rules and bottom lines for everyone.

I’m just one person. And who knows if anything I say will change anything? But I think I can help break down the variables and various parties involved in determining maternity leave in medical training so you guys aren’t as confused as I was going in.

Vacation

This is variable per program and typically you must exhaust your vacation time before other types of leave will kick in.

Sick leave

Also, variable per program and can be tacked on to your maternity leave. Typically exhausted after vacation.

ACGME

This regulating body requires that programs have a parental leave policy and that they inform their trainees of this policy upon entering. It also requires that programs communicate how prolonged leave affects satisfaction of graduation requirements. As of 2015, for endocrinology (my specialty) the ACGME leave requirements state: “The continuity patient care experience should not be interrupted by more than one month, excluding a fellow’s vacation,” but otherwise they do not specify amount of leave allowed by ACGME.

FMLA

A law that protects the jobs of certain employees for 12 weeks of unpaid leave per year. Companies with more than 50 people are subject to this law. Employees who have been with the company for more than 12 months are eligible. If you are a first-year resident or fellow, you may be out of luck.

Short-term disability (STD)

Your program may or may not have short-term disability for its trainees and some, but not all, plans will cover maternity leave. If covered, typically six weeks are covered for vaginal delivery and eight weeks for C-section. Coverage can change in special circumstance (e.g. you have complications and your OB says you are disabled longer and your disability application is approved by the company providing STD). Long-term disability (the kind of disability insurance those of us with our own disability insurance usually have) does not kick in until 90 days and your claim also needs to be approved in order to get payment.

Human resources (HR)

One of the roles of the human resources department is to ensure that the company is in compliance with laws and company policies. These may not be the same as ACGME and program-specific rules.

Program director (PD)

Your program director is responsible for a lot of things: staffing, graduating fellows, maintaining ACGME compliance to ensure funding, board pass rate, etc. Their interests may not align with yours on maternity leave; however, they will be a huge part of determining your time off and potential program extension. I recommend being equipped with your university/company STD policy (available from HR), your specific program’s parental leave policy (required by ACGME) and FMLA when you have the maternity leave discussion with your PD.

Don’t assume your superiors (PD, chief residents, attendings) know more than you when it comes to parental leave. I wish I’d realized this from the start. It is impossible to know the emotions and responsibility that come with motherhood before that tiny person comes out and changes your world. Just remember, your new baby depends on you 100 percent in the early days, and the time you are able to spend with them matters more to him or her than you.